Oral
Answers to
Questions

HEALTH AND SOCIAL CARE

The Secretary of State was asked—

Leaving the EU: Access to Drugs

John McNally: What steps he is taking to ensure access to drugs after the UK leaves the EU.

Douglas Chapman: What steps he is taking to ensure access to drugs after the UK leaves the EU.

Matthew Hancock: Our highest priority is for patients to continue to have access to medicines and medical products in all Brexit scenarios. As a responsible Government, we will minimise any disruption in our exit, deal or  no deal.
On 26 June, we set out our approach to ensuring continuity of supply. I discussed this last week with the head of the NHS, and Professor Keith Willett wrote to all NHS trusts yesterday to advise on no-deal planning.

John McNally: Concerned breast cancer charities have asked me and others to ask the Secretary of State if he will confirm to us, and to them, whether he is leasing enough ferry capacity to ship in medicines in the very likely event of shortages in the UK when we leave the EU.

Matthew Hancock: Yes, we secured the requirements ahead of a potential exit on 29 March, and we are doing the necessary work to ensure that capacity is available, whatever the Brexit scenario, on 31 October.

Douglas Chapman: My constituent Jonathan Fisher, known as the Bold Joff, has complex health needs due to a rare genetic condition called Lowe syndrome. He requires six regular medications, three of which come from the EU. They are all vital to his health, but one in particular, Epilim, is critical to his epilepsy care. What reassurances can the Secretary of State give to Jonathan and his mother, Fiona, that when we leave the EU there will be no disruption to his supply of this vital medication?

Matthew Hancock: The assurance I can give is that, ahead of 29 March, we put in place the measures that are necessary to ensure that the hon. Gentleman’s constituent and others get the medicines they need, and we have taken forward those proposals and that work ahead of an exit from the European Union on 31 October.

Daniel Zeichner: The Secretary of State will be aware of the expert evidence, including from the BioIndustry Association, warning that, although we may be able to stockpile the bog-standard drugs, it will be very difficult to do so for specialist treatments. What guarantees can he give that we will have access to those specialist medicines?

Matthew Hancock: Ahead of 29 March, we managed to put in place a full programme to ensure access to drugs. Of course, the approach is not just about ensuring stockpiles—there are adequate stockpiles for so many medicines all the time—but is about ensuring the flow of materials and finished drugs across the channel via ferries and, where necessary, aircraft.

Rural Areas: Health Service Funding

Anne-Marie Trevelyan: What steps he is taking to increase the level of funding for health services in rural areas.

Stephen Hammond: NHS England is responsible for funding allocations to clinical commissioning groups, which already takes into account the relative health needs of local areas. NHS England is now introducing a new community services formula, which will better recognise the needs of rural, coastal and remote areas.

Anne-Marie Trevelyan: Will the Minister update the House in more detail on how the Department plans to support CCGs such as Northumberland, where managing the extra costs associated with the extreme rurality of communities like the Coquet valley, the most rural in England, mean it simply is not possible for community nurses and general practitioners to reach as many patients in a day?

Stephen Hammond: Adjustments are already being made in the funding formula for differences in costs related to rurality or location. Northumberland CCG will receive an extra £1.1 million in funding this year to provide emergency ambulance services in sparsely populated areas. By 2023-24, Northumberland CCG will receive £98.5 million more funding.
My hon. Friend has already spoken to me about Rothbury Community Hospital in her constituency, and I would be delighted to speak to her about it again.

Ivan Lewis: People in rural areas need more investment in social care services. I do not always agree with the Daily Mail, but is it not right when it says that we now need a national dementia fund and an all-party approach to defining the nature and funding of the social care system in this country? Successive Governments have failed in that respect, and older people, disabled people and their families are being let down as a consequence. When will we see some action?

Stephen Hammond: The hon. Gentleman is right, which is why the Green Paper will have long-term plans on mental health and, indeed, dementia. I think he will be pleased to see that when the Green Paper is released shortly.

Desmond Swayne: What can the Minister do to expedite the provision of primary care services in those rural areas where the population is growing fast as a consequence of new housing?

Stephen Hammond: My right hon. Friend is right to raise that point, which has been raised with me several times. The new funding formula that the independent advisory committee is setting up will take into account the growth in population. It will look at the growth in the electoral register every year, rather than over a five-year period, as it does now, so it will be able to respond more quickly than is currently the case.

Dennis Skinner: Will the Minister bear in mind the fact that dementia comes in many different forms? My mother had one form and she lasted a number of years, but it finally took hold. My sister, on the other hand, went within a short period of time, because she would not eat at all. My best friend at the time in the National Union of Mineworkers, Peter Heathfield, finished his life being violent, struggling with three people who tried to get him to the toilet. Bear that in mind carefully, Minister. Dementia is not a static illness; it is very different for different people.

Stephen Hammond: I do not always agree with the hon. Gentleman, but he is right to make that point. I know from very personal experience that dementia affects people in different ways, which is why I am proud to be part of a Government who are committed to delivering in full on the challenge on dementia 2020, to make England the best country in the world for dementia care.

Tim Farron: The huge rural area covered by the Morecambe Bay NHS Foundation Trust has and needs three hospitals, but it is funded as if it had only one. As a result, the trust has been fined more than £4 million in debt interest over the past three years. That money could have been spent on nurses, paramedics or doctors. Will the Minister intervene to stop this at once?

Stephen Hammond: I met the hon. Gentleman recently to talk about ambulance provision in his constituency and the Morecambe bay area, and I hope he is now satisfied with the progress we are making on that. I will look into the individual case he mentions and respond to him.

Rural Areas: Access to Health Care

Anne Marie Morris: What steps his Department is taking to ensure the accessibility of health services for rural populations.

Stephen Hammond: The long-term plan that the Department published in January commits to delivering fully integrated community-based healthcare in primary and community hubs. It confirms  that the standard model of delivery will be developed for use in smaller acute hospitals that serve rural populations.

Anne Marie Morris: I thank the Minister for his answer, but some rural villages, including some in Devon, have no ambulance service at all—a fact masked by high-level statistical reporting. Will the Government work with me and the National Centre for Rural Health and Care to expose the real rural healthcare deficit, which is so masked, and work with us to rectify the situation and provide the appropriate care and medical support necessary by putting in place a robust and accountable rural health and care strategy and plan?

Stephen Hammond: I know that my hon. Friend has worked with the National Centre for Rural Health and Care and chairs the all-party group on rural health and social care. She is right to mention the fact that there are particular challenges in the delivery of the best-quality healthcare that we want to see in rural areas. I would be delighted to work with her and the all-party group on the matter.

Rosie Duffield: It has now been almost 18 months since health commissioners proposed that the two options for acute medical care in east Kent be put forward for public consultation. My constituents, particularly those in rural areas, are simply fed up with waiting for a new hospital. Will the Minister please confirm for me today just when a full public consultation on the future provision of acute services in east Kent will finally take place?

Stephen Hammond: The hon. Lady asks a good question on behalf of her constituents. I cannot confirm today when that will happen, but I will look into the matter and write to her to make sure that she gets the answer.

Emma Hardy: One in 10 women has endometriosis. The average wait for diagnosis is seven and a half years and can be even longer in rural areas, and there is currently no test for it. Researchers at the University of Hull previously developed biomarkers for cancer testing and have recently developed a project to test for biomarkers in urine to help to identify endometriosis. They need £10,000 in seed funding to get the project off the ground; will the Minister please meet me to discuss how we can secure the funding?

Stephen Hammond: The hon. Lady has invited me to meet her to discuss that funding. She will be pleased to hear that I will be delighted to do so.

Cystic Fibrosis Treatment

Ian Austin: What steps he is taking to ensure that people with cystic fibrosis receive the latest treatment for that condition.

James Frith: Whether he plans to hold a further meeting with Vertex Pharmaceuticals to ensure that new drugs to treat cystic fibrosis can be approved.

Seema Kennedy: We want patients living with cystic fibrosis to get the best care possible. Progress in specialised treatment for patients with CF means that people are living healthier and longer lives, but I recognise that it is frustrating for everyone, in particular patients and their families, that a deal on Orkambi has not been reached. It is for Vertex and NHS England to enter negotiations. I urge Vertex to consider the latest offer from NHSE.

Ian Austin: I have heard from people in Dudley and across the country about the difference that those new treatments make, but patients have been waiting for three and a half years now. Some families are having to take extreme measures to secure access to the drugs. Will the Minister and the Secretary of State meet me, people with cystic fibrosis or their parents, and the Cystic Fibrosis Trust so that we can get the whole thing sorted out and the wait for the drugs is not drawn out any longer with another summer or year of impasse?

Seema Kennedy: I recognise and share the frustration of patients and their families. The situation has been going on for far too long. I again urge Vertex to accept the offer. The hon. Gentleman has been in touch about a meeting, and I understand that we have responded to say that we will give him a firm date shortly.

James Frith: Sufferers of CF, as we have heard, are well used to the new hope of changes in the Government, but it soon becomes yet another false dawn: they are left drowning in their disease without access to Orkambi. The Minister has to lean in on the business end of the job that she has to do. Will the Government use their leverage, support the buyers’ club—the drastic action that CF sufferers are having to take—and supplement access to the equivalent of Orkambi? That might finally get Vertex to the table to do a deal on this important issue.

Seema Kennedy: As I said to the hon. Gentleman and other hon. Members in the Westminster Hall debate on the drug, a deal is the preferred option. However, the attitude taken by Vertex, which has been called an outlier in this situation, means that my right hon. Friend the Health Secretary has instructed NHS England to look at other options.

Sharon Hodgson: Over the past three years, all of us in this House have heard the numerous calls for Orkambi to be made available to cystic fibrosis patients. The Minister could go down in history if she takes the all-important step this week, while still in her job—I hope she will still be in the job tomorrow—of announcing an alternative route to access cystic fibrosis drugs, such as Crown use licence or clinical trials. Today, before we break for recess, will she commit to that so that families can have Orkambi now?

Seema Kennedy: The National Institute for Health and Care Excellence process is important, because it is an independent expert review and the way in which we allocate resources sensibly. The Crown use licence is not a quick or easy solution, and it is open to legal challenge, which might delay things even more. Vertex has been  offered the biggest settlement in NHS history, and I urge the company to accept it. However—I have said this on numerous occasions from this Dispatch Box and in Westminster Hall—the Secretary of State has urged and asked NHS England to look at other options, such as the ones to which the shadow Minister has referred.

Healthcare Staffing Levels

Kirstene Hair: What assessment he has made of trends in staffing levels of registered (a) doctors and (b) nurses since 2010.

Matthew Hancock: Across the UK, the number of registered nurses and doctors has increased over the past nine years. In England, there were over 112,000 doctors in NHS trusts in March 2019, 17,000 more than in March 2010, and over 8,000 more nurses than in 2010. There is more to do, and the NHS people plan will ensure a sustainable workforce for the long-term future of the NHS.

Kirstene Hair: As the Secretary of State may be aware, earlier this month—conveniently in the Holyrood recess—we learnt that medical students who come from the rest of the United Kingdom and want to apply for an undergraduate course at Scottish universities will find their chances greatly diminished. Most Scots are appalled by this policy. In fact, the British Medical Association, the Royal College of General Practitioners and medical schools are all expressing concern. Does the Secretary of State agree that the Scottish Government need to be attracting the brightest and the best—no matter where they come from across the United Kingdom—to address the GP crisis?

Matthew Hancock: Yes, I do. I was surprised by the recent news that I read about medical schools in Scotland being told to discriminate against medical students from elsewhere in the UK. I understand that the Scottish National party itself accepts that this is discriminatory. I doubt that the policy will last and I look forward to an SNP U-turn.

Rosena Allin-Khan: Mitie recently signed a £150 million contract at St George’s Hospital, but staff are already facing job cuts. My union, the GMB, balloted its members; 99.6% of them voted to take industrial action. Will the Secretary of State commit to visiting staff on the frontline and show them solidarity during this very difficult time?

Matthew Hancock: I am always very happy to visit hospitals around the country, including St George’s. Of course, the individual management of staff is a matter for the hospital itself. I look forward to discussing with the hon. Lady what more we can do.

Daniel Poulter: The Secretary of State has quite rightly outlined the global progress that has been made on the medical and nursing workforces, but he will be aware that the picture is very different in mental health services, with the loss of 4,000 mental health nurses over the last decade. Indeed, the fill-rate for doctors entering higher training in child and adolescent mental health services  this August is only 63% and only half the higher trainee posts in general adult mental health have been filled. What is the Secretary of State going to do to turn the very good rhetoric on mental health into a reality on the ground for patients?

Matthew Hancock: The increase in funding for mental health services, which is the largest increase as part of the overall £33.9 billion increase, goes to mental health services. Of course, the vast majority of that will go towards employing more people. As my hon. Friend says, we need to encourage more people into training in mental health services and psychiatry, as well as mental health nursing, which is also under pressure. The expansion of these services ultimately means that we need to have more people doing the work: supporting people to improve their mental health and supporting people with mental ill health. My hon. Friend is absolutely right to raise this issue, which is right at the top of the priorities for the NHS people plan.

Peter Kyle: Sexually transmitted diseases such as syphilis and gonorrhoea are on the rise. Will the Secretary of State target more resources at staffing and investment to ensure that we tackle this rise?

Matthew Hancock: We have recently announced that the way in which we are going to proceed with regard to sexual health services is co-commissioning between local authorities and the local NHS. This is the best way to ensure that we get the services on the ground. I would just slightly caution the hon. Gentleman; although he mentioned that some sexually transmitted diseases have been on the rise, others have been falling quite sharply. We have to ensure that we get the details of what we try to implement right, but I support the direction of travel that he proposes.

Andrew Selous: What can we do to make the workload terms and conditions more attractive for salaried GPs and GP partners compared with locums? GPs in my constituency tell me that a great number want to be locums, but that not so many want to be salaried or GP partners because of the workload. What can we do about that?

Matthew Hancock: My hon. Friend is dead right. This is an important part of the work that Baroness Dido Harding is leading in the NHS people plan to ensure that we can make careers in the NHS—whether as doctors, other clinicians or more broadly—the most attractive that they possibly can be. This week we announced a pay rise for doctors and earlier this month we announced a long-term agreement with junior doctors, which I am delighted they accepted in a referendum with over 80% support. But there is more work to do.

Martyn Day: The rules around annual and lifetime allowances are having an impact on the NHS workforce in Scotland, and the options contained in the recent consultation on doctors’ pensions do not provide the level of flexibility necessary to resolve this situation. We know that the solution lies with the Treasury, so what pressure can the current Secretary of State put on the Chancellor to ensure that urgent reform takes place to stop this terrible impact on our NHS workforce?

Matthew Hancock: I have been working hard with the Chancellor of the Exchequer to ensure that we can resolve this important issue. The hon. Gentleman will have seen the consultation document that we put out yesterday to resolve the problem. The consultation is open and asks open questions about the best way to fix it. I am absolutely determined that we will fix it to remove some of the unintended consequences of changes in pension tax law. It is a pity, though, that the SNP spokesman did not stand up to accept that the proposal mentioned by my hon. Friend the Member for Angus (Kirstene Hair) which would discriminate against people from outside of Scotland is wrong and should be withdrawn.

Julie Cooper: The Secretary of State is in denial. There is a crisis in GP retention. In fact, there are now 1,200 fewer fully qualified permanent GPs than there were in 2010. Because of this, patients are waiting longer than ever to get a GP appointment. He has promised, as he did again today, to address this, but it is a fact that the situation is getting worse, with a pension system that is effectively charging GPs to work extra hours. Does he really believe that this is the best way to retain GPs in the NHS? Does he have a detailed plan, and can he explain how he is going to sort out this mess?

Matthew Hancock: I think it is worth starting with a few facts. One fact is that I published a detailed plan yesterday, on which we are consulting, to tackle the pension issue. The other two facts that are worth noting, and that  the House will want to know about, are the following. First, there is a record number of GPs in training—3,473. Secondly, the overall number of GPs is rising, with, as of March 2019, 300 more doctors working in general practice than a year earlier. I want to see that number continue to rise.

Social Care Services: Accessibility

Afzal Khan: What recent estimate he has made of the number of people unable to access social care services.

Eleanor Smith: What recent estimate he has made of the number of people unable to access social care services.

Caroline Dinenage: All councils have a statutory duty to look after people’s care and support needs in their areas. In total, between 2016 and 2017, and in 2019-20, the Government have given councils access to £10 billion more social care funding.

Afzal Khan: Given that the Government have promised a spending increase for the NHS in the regions, is the Minister aware that at the current funding levels, Greater Manchester Health and Social Care Partnership will be operating on a predicted deficit of £2 billion by 2021? Will she advise on what work has been done in partnership with the GMHSCP to avoid this huge deficit?

Caroline Dinenage: There is no doubt that the system is under pressure, but that is why the Government have been putting an enormous amount of money in and giving councils access to additional funding to be able to address the growing need—up to £10 billion over the past three years. We know that people are living longer   and living with much more complex conditions. This situation is only going to get worse, so we do need to find a more sustainable way to deal with it in the long term. The hon. Gentleman will be interested to know that Manchester will receive an additional £42.9 million for adult social care funding in 2019-20.

Eleanor Smith: Figures from the Care and Support Alliance and Age UK show that at least 1.4 million older people in England are not receiving the care and support they need. We know that this figure will be much, much higher owing to the number of working-age disabled people who are being denied the care and support they need to lead better lives. Speaking as co-chair of the all-party parliamentary group on adult social care, how much longer do we need to wait until the Government publish the long-awaited Green Paper on social care and finally start to show some much needed leadership in this vitally important area of public policy?

Caroline Dinenage: First, I pay tribute to the hon. Lady for her work in the APPG on adult social care. It is really important that we have an APPG that represents this really important issue. As I said, the fact that we have an ageing population is a growing issue that we have to face as a nation, and, in fact, as a world. Her area of Wolverhampton will receive an additional £22.1 million for adult social care in 2019, but we know that that is not a long-term solution and we will be publishing a Green Paper at the earliest opportunity.

Martyn Day: The Government’s utter chaos over Brexit has already impacted on recruitment in the social care sector. Scottish Care told the Scottish Affairs Committee that providers have lost 67% of their intake from the European economic area. The fact is that this Government’s actions are putting the health of the sick and elderly at risk. Will the Government make an assessment of how the staffing crisis in social care is impacting on the rate of hospital admissions?

Caroline Dinenage: The hon. Gentleman is right: we do have a number of vacancies—a large number of vacancies—in adult social care. That is why, earlier in the year, the Government announced a recruitment campaign, “Every day is different”. It ran for a few months, with enormous success. There have been 14% more apply clicks on the relevant Government jobs site as a result, so we have just announced that we are going to expand and extend that recruitment campaign, with an additional £4 million of funding.

Barbara Keeley: Among those most affected by lack of access to social care are the 2,300 autistic people and people with learning disabilities stuck in inappropriate in-patient units because of a lack of funding for community placements. Labour, my party, has pledged to spend £350 million per year to support moving as many of those people as possible into community placements. I note that the Health and Social Care Secretary actually pledged extra funding for social care if he became Prime Minister, so will the Care Minister tell us if he now promises to match Labour’s pledge and ensure that autistic people and people with learning disabilities can live in homes, not hospitals?

Caroline Dinenage: The hon. Lady is absolutely right. One of the biggest issues we have had with people with learning disabilities and autism ending up in in-patient settings is a lack of community provision. That is why the NHS long-term plan commits to an extra £4.5 billion a year for primary and community health services, and local areas will be expected to use this investment to develop the sort of specialist services and community crisis care that will help divert people away from in-patient care settings.

Mental Health: Young People

John Howell: What steps his Department is taking to help prevent mental health illness among young people.

Jackie Doyle-Price: We are committed to improving early intervention and prevention to ensure that young people with mental health problems do get the best start and the earliest possible treatment. To that end, we are introducing new school-based mental health support teams. The first 59 of these will start being operational by the end of December this year. The next wave of 124 more teams was announced on 12 July.

John Howell: With half of all lifetime cases of mental ill health beginning at the age of 14, will the Minister say how well the training promised to constituencies such as mine will help to stop these problems worsening as people get older?

Jackie Doyle-Price: My hon. Friend is right: people with mental health conditions do tend to develop them as children. Clearly, the earlier we can give them support to help them manage those conditions, the better for their long-term wellbeing. Equally, however, we need to make sure we have sufficient community services when they leave school and get older, so that having invested in their wellbeing, it can be continued through later life.

Paul Williams: Is the Minister confident that the mental health of the 5,000 children with special educational needs who spent time in school isolation booths last year was not harmed, and if not, what representations has she made to the Secretary of State for Education about this practice?

Jackie Doyle-Price: The hon. Gentleman, as usual, raises a very important issue indeed. Of course, people with special educational needs will be at risk of mental ill health more than any other cohort of children.  I am having regular meetings with the Under-Secretary of State for Education, my hon. Friend the Member  for Stratford-on-Avon (Nadhim Zahawi), who has responsibility for children and families, about this very vulnerable group. Having targeted mental health provision across mainstream schooling generally and put in such investment, we now really need to home in on the groups at highest risk.

Jim Shannon: Will the Minister outline what discussions have taken place with the devolved Administrations to ensure that best practice and best results are implemented UK-wide, especially   considering that Northern Ireland has the highest level of mental health issues pro rata in the whole of the United Kingdom of Great Britain and Northern Ireland?

Jackie Doyle-Price: As usual, the hon. Gentleman raises an extremely important point. Of course, health is a devolved matter, but that is not to say that all four nations cannot learn more from best practice in each place. I am pleased to say that we are now increasing our contact with representatives of the devolved Governments, and we will very much be sharing such best practice.

Paula Sherriff: Referrals to child mental health units from primary schools for pupils aged 11 and under have risen by nearly 50% in three years. BBC research last week also found that primary school children are self-harming at school, and in four cases children under 11 had attempted suicide while at school. This is deeply shocking, so what is the Minister doing to ensure that primary school children will have support from trained mental health professionals when they return in September?

Jackie Doyle-Price: The hon. Lady is quite right to raise that, and it is incredibly troubling to see those figures. The investment we are making in mental health support teams will be of assistance. For primary schools that are well led and gripping this issue, there is some very imaginative and innovative practice to bring emotional wellbeing into the classroom from the moment pupils arrive. We need to make sure that those mental health teams start acting as soon as possible. This is something that we need to address collectively with schools and as a society to make sure that we get treatment to people at the earliest possible time.

NHS Facilities

Jack Brereton: What steps he is taking to improve NHS facilities.

Stephen Hammond: Modern, fit-for-purpose facilities are better for patients, the NHS staff who work in them and the taxpayer, so the Government have already provided £3.9 billion of new capital investment to deliver new, upgraded facilities across the country.

Jack Brereton: I thank the Minister for visiting the site of the proposed new Longton health centre in my constituency recently. Does he agree that we must deliver new primary care facilities such as this to make sure that improvements in health in my local community continue?

Stephen Hammond: I very much enjoyed the visit. The new £5 million Longton medical centre will provide general practice service for more than 12,000 patients, and it will be a fantastic community health scheme. My hon. Friend will be pleased to hear that yesterday I wrote to him outlining the capital options that might be available. He is right, and that is why this Government believe in transforming the primary care estate. It is a key enabler for delivering the long-term plan, and it provides better care for patients.

Rachael Maskell: A year on, NHS Property Services is now having to remarket the site of Bootham Park Hospital. In the light of this complete failure and the failure to listen to health professionals locally, will the Minister ensure that the One Public Estate bid is seriously considered as the sale moves forward?

Stephen Hammond: I met the hon. Lady about this disposal last December, and I have followed the matter carefully. The local health system has not wanted to continue using the site, but I am happy to assure her that I will look at bids from all comers. It is not my decision; it is a decision for local healthcare bodies and NHS Property Services.

Derek Thomas: The Minister will be aware that our general district hospital was closed to new admissions in recent weeks, and the reason given was delayed transfers of care. Ever since I was elected, many others have joined me in looking at how we can provide a step-down, step-up facility—a community healthcare hub—with beds in the St Ives constituency. I wonder what funding is available to achieve that aim.

Stephen Hammond: My hon. Friend is right. He will have heard me say in response to my hon. Friend the Member for Stoke-on-Trent South (Jack Brereton) that we are already making available £3.9 billion extra to provide these facilities. We should not be complacent, however, and it is important to recognise that we want world-class facilities for world-class care. One of the benefits of the long-term plan is that we can create a stable environment for capital investment, and we can make the case for more capital investment at the spending review.

Emma Lewell-Buck: Government cuts have already resulted in significant downgrading and loss of vital services at South Tyneside District Hospital. Since the Department refused to fund the next phase of downgrading, the trust has approached the local authority to borrow £35 million from the treasury to see it through. Does the Minister agree with me and my incensed constituents that it is wrong that we are now being asked to pay for further cuts to our hospital?

Stephen Hammond: The hon. Lady will know that the Government are putting more cash and more money into the NHS than at any other time in its history. There will be £33.9 billion extra going in by 2023-24.

NHS Workforce Vacancies

Karen Lee: What recent estimate he has made of the number of NHS workforce vacancies.

Matthew Hancock: Question 10 is about workforce vacancies, and I can tell the House that one workforce vacancy has just been filled, because Boris Johnson has just been elected as the leader of the Conservative party.
The NHS employs more staff now than at any time in its 70-year history, with significant growth in newly qualified staff from 2012. Our full people plan will help to tackle these issues for the long term.

Karen Lee: Words are all well and good, but it is actions that actually count, and the Government are not creating a health service that supports its workforce. The striking health visitors in Lincolnshire have each lost more than £2,000 a year since they were transferred from the NHS to the Conservative-controlled county council and many have had their professional status downgraded. Does the Secretary of State agree that rather than shifting the responsibility for cuts to health services on to local government, the NHS should deliver fully resourced healthcare services and pay its staff properly?

Matthew Hancock: The NHS is delivering healthcare services and it is paying its staff properly. It is working with local authorities to deliver the best possible health services right across the country. We absolutely need to recruit more people to the NHS and we are recruiting more people to the NHS.

Vulnerable Older People

Barry Sheerman: What steps he is taking to ensure that (a) adequate resources and (b) highly trained personnel are allocated to health services for vulnerable older people.

Stephen Hammond: The NHS is responsible for ensuring adequate resources and a high-quality workforce that can deliver a comprehensive health service for all people, including vulnerable older people. That is clearly happening. We are supporting that through investing an extra £33.9 billion in the NHS.

Barry Sheerman: I have also just heard the news that we have a new Prime Minister. I am thinking of the man who stands outside with a sign saying that the end of the world is nigh.
The fact of the matter is that the end of life for many of my constituents is tough, because the people in the care sector who support them are poorly paid, poorly resourced and poorly trained. Surely we should go for well-managed, highly trained, highly skilled people in the NHS for every age?

Stephen Hammond: The hon. Gentleman is right, which is why we have ensured that we are putting more money into the NHS and more money into primary care, with £4.5 billion in real terms on primary medical care and community health services. It is why we commissioned Baroness Dido Harding to produce the “Interim NHS People Plan”, which she has done, and why we are working on ensuring that we have the health service workers to provide excellent care for all people in the community.

Health Inequalities

Virendra Sharma: What assessment he has made of the effect of public health services on reducing health inequalities.

Jackie Doyle-Price: The Government recognise the importance of reducing inequalities and have included a commitment to that in the NHS long-term plan. We know that public health services, such as immunisation, screening programmes, smoking cessation services and many other initiatives, can significantly improve health outcomes to combat some of the inequalities faced by ethnic minorities and those living in less affluent areas.

Virendra Sharma: I thank the Minister for her response. After nine years of Tory austerity, advances in life expectancy, which steadily increased for 100 years, have now ground to a halt and have even gone backwards in some of the poorest areas. How does the Minister plan to reverse that damning trend?

Jackie Doyle-Price: Life expectancy has been increasing year on year, but it is also true that it is an international phenomenon that that rate of increase is coming to a halt. None the less, life expectancy in England is the highest it has ever been: 79.5 years for men and 83.1 years for women. We will continue to invest in our public health programmes and look at the wider issues facing society that can also contribute to good health outcomes, such as housing, work and so on. There is a lot that can be done; it is not just about NHS spending.

Tim Loughton: One of the best ways of getting early public health help across the doorstep is by investing in health visitors to give that much needed early support, especially to new parents to help to ensure that every child gets the best start in life. One of the best achievements of the Cameron Government was the creation of 4,200 additional health visitors. Does the Minister share my concern that since 2015, with the responsibility now having gone to local government, there has been a 26% reduction in the number of health visitors? That is something of a false economy.

Jackie Doyle-Price: I do share my hon. Friend’s belief that health visitors are probably the most important army in the war against health inequalities. They provide an intervention that is very family-based and not intimidating. It is based on good relationships and means we can provide intervention at the earliest possible time. He is right to highlight the massive investment we made during the Cameron Government. There has been a decline since, which we really must address if we are to get the earliest possible intervention and the best health outcomes for children.

Sarah Wollaston: We finally got to see the prevention Green Paper yesterday evening, and it rightly highlights the appalling inequality in healthy life expectancy and the fact that being overweight or obese is now the leading risk factor for disability and years lived with disability. Will the Secretary of State please reassure the House that he will act on the evidence? The prevention Green Paper makes it very clear:
“The Soft Drinks Industry Levy…has been hugely successful in removing the equivalent of over 45,000 tonnes of sugar from our shelves.”
The House really needs to hear reassurance that we will not roll back on those kinds of issues.

Jackie Doyle-Price: I reassure the hon. Lady that the Government are committed to following the evidence; that is very much a theme in the prevention Green Paper. The evidence will speak for itself. Clearly, she  is absolutely right to highlight obesity as the biggest  risk factor in impeding healthy life expectancy. That is  why, across Government, we should be vigilant about tackling it.

King George Hospital A&E Department

Mike Gapes: Whether his Department’s decision of October 2011 to close the A&E department at King George Hospital, Ilford, has been rescinded; and if he will make a statement on future services at that hospital.

Stephen Hammond: The hon. Gentleman will be pleased to hear that I can confirm that there will continue to be an A&E at King George Hospital, Ilford. The NHS has concluded that there is need for such provision now and in future.

Mike Gapes: I thank the Minister for that reply. I hope that it will stop some of the more lurid scaremongering and campaigning, which is unfortunately diverting people in my constituency from looking at the most important issue: how we use the King George Hospital site in future. Will he confirm that steps are being taken to integrate North East London NHS Foundation Trust and King George Hospital services to deal with social care and other matters?

Stephen Hammond: I am happy to confirm that.

Autism and Learning Disabilities

Kerry McCarthy: What additional funding he plans to allocate to the NHS to reduce the number of people with autism and learning disabilities held in in-patient settings.

Caroline Dinenage: The NHS long-term plan commits to an extra £4.5 billion a year for primary and community health services by 2023-24. Local areas will be expected to use part of this investment to develop specialist services and community crisis care to reduce avoidable admissions and lengths of stay for autistic people and those with learning disabilities.

Kerry McCarthy: I do not know whether the Minister has seen the report from the Children’s Commissioner, but it says that the number of children with autism or learning difficulties in mental health hospitals has doubled in recent years. Many are very far from home. Their parents are not consulted properly on their care, and they are in for much longer than they need to be. What proportion of the money that she mentions will go towards trying to ensure that children can have support in their home, so that they are not in this situation?

Caroline Dinenage: The hon. Lady has hit on a really important point. The truth is that a lot of children who end up in an in-patient setting are not diagnosed with autism or a learning disability until they are there; they normally come in on a mental health diagnosis. There are a few points to make here. One is on making sure  that early intervention is there as early as when a child is in school. That is why the Government have made a commitment to having mental health support available from a very early age, in schools. This is also about making sure that families do not get to crisis point,  and that the investment is there in the community, so that children get the support that they need at every possible step.

Missed GP Appointments

Gordon Henderson: What steps he is taking to reduce the number of missed GP appointments.

Seema Kennedy: Missed appointments are a waste of NHS resources, and we believe that encouraging patients to use the NHS sensibly and responsibly is the right approach. We are encouraging  a range of local schemes to help to reduce missed appointments, with clinical commissioning groups and practices embracing technology and adopting a variety of approaches, such as text reminders, patient-recorded bookings and the increased use of online systems that make it quick and easy for patients to change and cancel appointments.

Gordon Henderson: A GP surgery in my constituency has reported that in one month this year, 78 people failed to keep their appointment and failed to cancel it. Those failures led to the surgery losing 11 hours’ working time. The surgery has announced that it will consider removing patients from its register if they miss three consecutive appointments. Does my hon. Friend support that proposal, and does she think that the policy should be rolled out across other surgeries?

Seema Kennedy: Local NHS organisations know their populations best, and that is why the Government support locally led initiatives to reduce missed appointments. The evidence shows us that people are less likely to miss an appointment if they have a convenient option. Swale CCG has a “Did Not Attend” campaign, which will run across the region this summer and support his constituents in making sure that they use their appointments responsibly.

Gregory Campbell: Is the Minister aware of any research that has been done, not just on missed appointments, but on repeat offenders who periodically miss their appointments, and the effect that has? What can be done to ensure that that is not repeated beyond today?

Seema Kennedy: There is no overall estimate of the number of people who miss their appointments. We want to encourage people to be responsible, but we also want to make booking appointments as easy as possible by having things such as online and text booking. NHS England will shortly conduct an access review, which will look at ways of developing a coherent offer to patients in terms of how they access their practice appointments. We will therefore make things easier, and hopefully bring down the number of people who miss an appointment.

Strategy and Action Plan: Improving Lives

Sarah Newton: What progress has been made on implementing his Department’s strategy and action plan, “Improving lives: the future of work, health and disability”, published in November 2017.

Jackie Doyle-Price: I am pleased to say that we have made strong progress against the commitments in the Command Paper my hon. Friend refers to, and I thank her for her role in delivering those advances. I can advise the House that the number of disabled people in employment is now 400,000 higher than it was in 2017. There is, however, much more to do, and on 15 July we launched a consultation on measures to reduce ill health-related job loss. We are seeking views on how employers can best support people with disabilities and people with long-term health conditions to stay and thrive in work.

Sarah Newton: I thank the Minister for her really helpful response, and I congratulate her on the fantastic work she has done in her position. Last week, the next Prime Minister announced his intention to look again at the tax treatment of at-work referral health services as a benefit in kind to employees, given how crucial fast access to health and support is to so many people. Will the Secretary of State and the Minister work with the new Prime Minister in bringing forward an urgent review, as the current tax regime goes against our focus on prevention and reducing demand on the NHS?

Jackie Doyle-Price: Absolutely. We will continue with the emphasis on work being good for people’s health. We need to look at what we can do to make it easier for employers to help their employees, which is good for everybody—it means that everyone can still make an economic contribution, and that we retain the existing workforce, and it is good for people’s wellbeing. We absolutely will look at what we can do to incentivise best practice.

Gareth Thomas: It is difficult to see how lives will be improved and people supported to stay in work by NHS England’s decision, supported by Ministers, to encourage CCGs to phase out their walk-in centres—I am thinking, in particular, of the three walk-in centres that serve my constituents. I urge Ministers, even at this late stage, to set aside new funding streams so that Alexandra Avenue, the Pinn and Belmont Health Centre can continue to provide a 365-day, 8 am to 8 pm walk-in service to my constituents.

Jackie Doyle-Price: I do not share the hon. Gentleman’s view on this. Clearly, it is important for CCGs to have the freedom to determine their best primary care arrangements. Walk-in centres are convenient for people who are in work and who perhaps work away from home, but ultimately, we keep people with disabilities in work by having bespoke support for them, and that is better organised by having good primary care services near the home.

Topical Questions

Paul Sweeney: If he will make a statement on his departmental responsibilities.

Matthew Hancock: This week, the Department has released a consultation on the future of clinicians’ pensions, a new five-year deal to support our approach to community pharmacy, the Government’s prevention Green Paper and a £20 million collaboration with the Prince’s Trust for the NHS widening participation initiative, which will allow and support more apprentices into the NHS. There has been a lot done just this week, and there is a lot more still to do.

Paul Sweeney: Another item for the Secretary of State’s list might be to engage with his counterpart in Scotland on the issue of the NHS taper on the pensions programme. When I raised the issue with a Treasury Minister, she seemed unaware that there was more than one NHS  in the UK. If there is some co-ordination and joint representation to the Treasury, that might assist matters. Would the Secretary of State agree?

Matthew Hancock: Of course, in solving this problem, many of the changes can take place within the NHS, and we are working on that with the Treasury. I am happy to ensure that discussions take place with devolved colleagues, but of course, the NHS is devolved in Scotland.

Rachel Maclean: Provision of in vitro fertilisation in Redditch has been reduced from two cycles to one. I warmly welcome the work that the Minister has done to increase equity across the country, but what more can she do to address the postcode lottery in this and other areas, such as hip and knee surgery?

Jackie Doyle-Price: My hon. Friend is right: the postcode lottery is not acceptable, and patients manage to get around it; my local clinical commissioning group, having funded three courses of IVF, has had to reduce that to two, because demand has doubled owing to the lack of provision in neighbouring CCGs. I have made it very clear that it is unacceptable for any CCG to offer no IVF cycles at all; I have given them that guidance.

Jon Ashworth: My I pursue the question asked by the Chair of  the Select Committee, the hon. Member for Totnes (Dr Wollaston)? We know that obesity is a major cause of cancer and other diseases, and we know that we have severe rates of childhood obesity, so why does the prevention Green Paper say only that the sugar tax “may” be extended to milkshakes? The evidence is clear. Is the Secretary of State not kicking this into the long grass?

Matthew Hancock: I have asked the chief medical officer to review the evidence to ensure that our policy for tackling obesity is evidence-driven. Follow the evidence: that is what we do on this side of the House.

Jon Ashworth: A year ago the Secretary of State said, to great fanfare, that prevention was one of his priorities. Now the prevention Green Paper has been sneaked out in the night on the Cabinet Office website. Health inequalities are getting wider and wider, and life expectancy is stalling, but the Secretary of State still cannot give us any clarification on the future of the public health ring-fenced grant. Is it not the truth that he has buckled under pressure from the sugar industry, is not taking on the alcohol industry, and is not taking on the tobacco industry? That is more about trying to get in with the new Prime Minister than putting the health needs of the nation first.

Matthew Hancock: I thought that the hon. Gentleman would welcome the prevention Green Paper, which was published yesterday. We have been working very hard to publish a huge amount of policy, including the Green Paper, which contains about 80 different policies to ensure that we prevent people from becoming ill in the first place. However, it is also part of a broader drive, which Conservative Members support, to ensure that we are the healthiest of nations, and that people can take personal responsibility for their health, as well as relying on the NHS, so that it is always there when people need it.

Kevin Hollinrake: Has the Secretary of State given further consideration to providing extra funds to meet the challenges of running unavoidably small hospitals, such as Scarborough and the Friarage in Northallerton?

Stephen Hammond: My hon. Friend has campaigned on this matter for a while, and I was pleased to meet him to discuss it earlier in the year. We absolutely recognise the challenge that small acute providers face, and over the past two years the Advisory Committee on Resource Allocation has been considering how we might meet that challenge. The committee has endorsed a new community services formula to reflect the pressure in remote areas, which may help the two hospitals mentioned by my hon. Friend.

Tracy Brabin: My constituent Catherine is undergoing post-operative breast cancer treatment. A new drug, Pertuzumab, which has been approved by the National Institute for Health and Care Excellence, has been shown to improve a woman’s life chances. The drug was prescribed for Catherine by her oncologist at the Mid Yorkshire Hospitals NHS Trust, but that was overruled by NHS England, although in the neighbouring trust patients are allowed it. Can the Minister guarantee that women who could extend their lives by taking this drug have access to it, no matter where they live?

Seema Kennedy: When drugs have been approved by NICE, there is an obligation to prescribe them. If the hon. Lady will write to me, I shall be able to look into this matter more closely.

Paul Masterton: I welcome the consultation on NHS pensions that was announced this week, and while I do not think that 50:50 is the  ultimate solution, I welcome the invitation to present other proposals. However, given that this is causing an issue now, how quickly does the Department think that it will be able to turn the outcome of the consultation into action?

Matthew Hancock: We are working very hard to turn it into action as soon as possible, and I can give my hon. Friend an absolute commitment that the new rules will be in place in time for the new financial year.

Barry Sheerman: I am not going to shout at the Secretary of State this morning, but I will say to him that Huddersfield is a typical town, and a lovely place in which to live and work. Given that it is so attractive, why is it so difficult for us to find doctors and dentists who can give a good service to my constituents under this modern NHS?

Stephen Hammond: The hon. Gentleman will know that the Government have produced an interim people plan setting out the course and the trajectory that will mean more doctors and nurses being trained. He will also know that we have opened new medical schools this year, and that more doctors are now being trained.

Kirstene Hair: I should declare that I am chair of the all-party group on eating disorders. Despite eating disorders affecting 1.25 million people across the UK and being the most deadly of mental health issues, the average time dedicated to training about eating disorders in a five-year medical degree was found to be only three or four hours; in some cases, there was none at all. Will the Minister agree to look into this and perhaps report back to the all-party group?

Jackie Doyle-Price: I certainly will. This recommendation was also made by the Public Administration and Constitutional Affairs Committee following its report into the death of Averil Hart, and we are in discussions with the royal colleges to see what more can be done, in terms of training medical staff and doctors in mental health, because we want to make sure that intervention happens at the earliest possible stage, which means that all our medical professionals need to understand it better.

Paul Blomfield: Constituents of mine recovering from mental health problems have told me that when they have shared their desire to return to work with jobcentre staff, jobcentre staff have used that as a trigger to move them from employment support allowance to jobseeker’s allowance, with, obviously, the financial loss involved in that. Do Ministers agree that whoever is still in their job by the end of the week could usefully talk to the Department for Work and Pensions team about how people with mental health problems can be supported back into work without being penalised?

Jackie Doyle-Price: Yes is the short answer, and the hon. Gentleman will be pleased to know that I have regular discussions with colleagues in the DWP to see what we can do to humanise all our processes for benefits claimants, because it is important that when people suffering from mental ill health interact with   organisations of the state, we are not causing them harm. I can assure the hon. Gentleman that that is very high on the list of things in my in-tray.

Sarah Newton: I greatly welcome the publication of the prevention Green Paper. How will that strategy enable people to keep well by living in warm homes?

Matthew Hancock: Clearly, the need for join-up across Departments of Government is a vital part of this agenda, as my hon. Friend knows from her work across different Departments; the specific point she raises is one example of that, and we must drive it forward.

Chi Onwurah: In the north-east, we die on average two years younger than in the south. The Northern Health Science Alliance estimates that that costs our economy £13 billion a year, on top of the emotional and personal costs. The Secretary of State talks a lot about technology in health, but what is he doing about equality in health—or should I ask Alexa?

Matthew Hancock: Technology and the data that show these inequalities are an important part of the answer, but of course it is much broader than that, and tackling health inequalities is an underpinning part of the long-term plan for the NHS; it is absolutely critical in order to address the sorts of inequalities that the hon. Lady rightly raises.

Ruth George: Life skills courses can be key to helping people out of depression, loneliness and isolation, and into work and training, yet the course in Glossop in my local area has been cut by the county council, in spite of it having a £2.8 million underspend this year. Do Ministers agree that local authorities should be looking to spend the public health money that they have, and to use it effectively?

Matthew Hancock: Yes, emphatically we do, and there is a drive across the country for more of the sort of social prescribing that the hon. Lady talks about. The clinical solution to many people’s health issues, and in particular mental health challenges, is often about changes in behaviour and activity, and the support people are given, rather than just drugs. On the face of it, the project the hon. Lady mentions sounds very good; of course I do not know the details, but I would be very happy to look into it. However, we wholeheartedly and emphatically support the broad direction of travel of helping people to tackle mental illness both through drugs where they are needed and through activity and social prescribing.

Clive Efford: I recently met three care workers who work for Sanctuary Care. Between them, they have 60 years of experience of, and dedication to, caring for vulnerable people, but Sanctuary Care has decided to cut their pay and conditions because they were TUPE-ed over from the Borough of Greenwich. Is this the way to treat dedicated care staff? Will the Minister meet me and those care staff to discuss what is going on at Sanctuary Care, whose chief executive gets a handout of almost a quarter of a million pounds a year, while it cuts low-paid staff’s wages?

Caroline Dinenage: I thank the hon. Gentleman for raising that, because one of the things that I have learned in this role is that working in care should never be described as unskilled. It is probably one of the most skilled professions, and it requires people with exactly the right principles and values to deliver it. We are clear that people should be paid a fair and decent wage, and I am more than happy to meet the hon. Gentleman to discuss it further.

Helen Goodman: The Minister with responsibility for mental health is a very sympathetic person. Unfortunately, that does not seem to translate into action. Our clinical commissioning group has stopped funding the voluntary sector to provide counselling, and now it is taking counselling services out of GP surgeries as well. Will she look into that?

Jackie Doyle-Price: Yes. What the hon. Lady has just outlined to me flies in the face of the advice that I and the clinical directors of NHS England are giving CCGs. We are clear that the voluntary sector provision of additional services is crucial in the support of people with mental ill health. Unfortunately, some commissioners seem to want to medicalise everything, but that is not the key to good treatments, and I will look into it.

Alison Thewliss: The prevention Green Paper talks about the risk of an opioid epidemic. In Scotland, we feel that that is already here, with 1,187 deaths in Scotland last year, 394 of them in Glasgow. Will the Secretary of State work with the Scottish Government and Glasgow health and social care partnership and support the opening of a medically supervised drug consumption room in Glasgow?

Matthew Hancock: Yes, the risk of an opioid epidemic across the UK is a serious one. We have seen that risk materialise in the United States. I was as shocked as anyone to see the recent figures for the growth in opioid addiction in Scotland. While public health and the NHS are devolved to the Scottish Government, and they must lead on tackling this issue, for the UK elements of my responsibilities, we in England will do absolutely everything we can and put aside all party politics to tackle this serious problem.

Several hon. Members: rose—

John Bercow: Two hon. Members who are standing have not been heard this morning.

Ruth Cadbury: In January the Health Secretary declared air pollution a health emergency, yet today, tomorrow and Thursday we will see ozone layers in the south and south-east of England that will be a health hazard to the old, the young and the sick. Unlike in equivalent situations in other countries, the Government have released no warnings to people or advised how they should take appropriate action. How bad does air pollution have to get before the Government use their not inconsiderable communications budget to warn people to take appropriate action?

Matthew Hancock: We have. Through Public Health England, which is the responsible agency, we have absolutely put out communications, which I heard this morning.  The communications that the hon. Lady asks for are out there. Of course air pollution is a significant risk to public health. I am delighted that it is falling to its lowest levels since the industrial revolution, but there is clearly much more that we need to do.

Thelma Walker: Can the Secretary of State confirm that the Care Quality Commission has recently inspected Calderdale and Huddersfield NHS  Foundation Trust, and that patient safety was raised as an issue during that inspection? If that is the case, what action is he taking?

Caroline Dinenage: Clearly, patient safety is a massive priority for the Government. I do not know the exact details of the site that the hon. Lady is talking about, but if she would like to drop me a line, I will definitely find out and get back to her.

PERSONAL INDEPENDENCE PAYMENTS: SUPREME COURT RULING

Chris Stephens: (Urgent Question): To ask the Secretary of State for Work and Pensions if she will make a statement on last week’s Supreme Court ruling on personal independence payments for those with mental health issues.

Justin Tomlinson: The Supreme Court has ruled on the case of Secretary of State for Work and Pensions v. MM, which is known as MM. The case was about the definition of “social support” when engaging with other people face to face in the PIP assessment, and how far in advance that support can be provided.
We took the case to the Supreme Court because we wanted clarity on the issue and the judgment gives us that clarity. We welcome the court’s judgment. We are pleased it accepted that there is a difference between “prompting” and “social support”, and that there must be a need for social support to be provided by someone who is trained or experienced in providing such support.
PIP is already a better benefit for people with mental health conditions than the legacy disability living allowance. The proportion of them who get the higher rate of PIP is five times higher than under DLA, with PIP at 33% and DLA at 6%.
It is clear that there is an increasing understanding in society about mental health and how important it is to make sure that individuals with poor mental health get the right help. It is not an exact science, but the desire for an increased understanding of mental health issues is one of the few areas that has cross-party support.
Getting this clarity ensures that even more people who need help to engage face to face may now be eligible to benefit under PIP. I want to be clear that supporting disabled people and those with mental health conditions continues to be a priority for this Government. That is why we will now carefully consider the full judgment and, working with disabled people and engaging with Mind and other stakeholders, implement it fully and fairly so that claimants get the PIP support they are entitled to.

Chris Stephens: I thank you, Mr Speaker, for granting the urgent question and the Minister for his response.
The individual concerned in the case is a Glasgow South West constituent. As the Minister said, the Department appealed the decision by the Scottish courts.
Will the Minister confirm that the judgment means that ongoing encouragement from a family member to help someone leave their house and engage socially will result in additional points in the PIP process? Does he accept that it is now clear that PIP assessments need to be overhauled and that, once again, we have found that the process discriminates against those with psychological conditions?
The Minister appears to accept the judgment, so will he tell us whether any estimate has been made of the number of people who will be affected by the decision and how long it will take to initiate any back payments? Will he confirm that that will be new money and that it will not come out of existing budgets?

Justin Tomlinson: I thank the hon. Gentleman for his questions. I pay tribute to him, because through his constituency work and as a valued member of the Select Committee on Work and Pensions, he has been a real champion in this area.
I repeat that the Government are committed to supporting people with mental health conditions. I push back on the suggestion that PIP needs fundamental reform, because only 6% of claimants with a mental health condition were able to access the highest rate of support on legacy benefits, compared with 33% under PIP.
We recognise that there is more to do. That is why we will engage with stakeholders and disabled people. We have already met Mind since the judgment was passed down. We want to get this right and to ensure that people are treated fairly and are fully supported. I cannot give an exact timeline but, as with all legal judgments, we will update the House once we have had time to consider it. We do, however, take this very, very seriously.

Sarah Newton: I commend my hon. Friend for the excellent job he is doing and for his statement. He is right that more people with mental health conditions are receiving more support than ever before, but clearly there is more to do. Will he kindly update the House on the progress that is being made on training Department for Work and Pensions staff—not just the PIP assessors, but the people in the jobcentres and the people who pick up the phones—to make sure that everybody has a positive experience and is treated with respect and dignity?

Justin Tomlinson: I thank my hon. Friend, who did so much in this role before me and is widely respected across the House. She is right to highlight how much more is done in terms of training. I am grateful for the support of the stakeholders who helped to shape that training. One of the biggest improvements is that we now have a mental health champion in each PIP assessment centre who can support claimants who may be more anxious when they arrive to make sure that their experience is as positive as can be.

Margaret Greenwood: This landmark judgment by the Supreme Court should act as a serious wake-up call for the Government.
According to Mind, more than 425,000 people with conditions classed as psychiatric disorders have been turned down for PIP. What percentage of those people would have been successful in the light of this judgment? Will the Minister be clear that the Government will look again at those cases where people have been turned down?
The assessment framework for PIP is not fit for purpose and has created a hostile environment for disabled people. After the ruling, Mind commented:
“Far too many are struggling to claim benefits they need because of draconian assessments, which often fail to take fully into account the impact a mental health problem can have.”
Does the Minister agree? Many people with mental health problems can feel socially isolated, so surely the Government should be providing a system that supports people in need.
It was revealed recently that more than 60,000 appeals against the tests for PIP ruled against the Government in 2018. That is 72% of all tribunals. Clearly this is wholly unjust. The fact that such a high proportion of PIP assessments are overturned on appeal speaks volumes about the failings of the Government’s record when it comes to providing support to disabled people. Ill and disabled people should not have to fight through the courts to receive the support that they are entitled to. Ministers at the Ministry of Justice recently revealed that the Government spent £26.5 million in 2018 on PIP hearings that ruled against the Department. The Minister must surely also be aware that the introduction of PIP has ended up costing the taxpayer more than the system it replaced, so will he commit today to scrapping the cruel and discredited PIP assessment framework and replacing it with one that treats disabled people with the respect they deserve and provides them with the support they need?

Justin Tomlinson: To repeat: we do welcome the judgment. It was the Government who referred this matter to the Supreme Court to get clarity. Across society, there is a deeper understanding of mental health, and that is welcome. This is not an exact science, but it is one of the few areas where there is cross-party support as, together, we get a better understanding of how to identify and support people with mental health conditions. This will be a complex exercise, and we will need to work carefully through the detail of the judgment before we start the exercise of checking claims. We are committed to doing that as soon as we can, working with disabled people and stakeholders, so that we can pay people as quickly as possible. I remind the hon. Lady that we are committed to supporting those with disabilities and long-term health conditions. We are now spending £10 billion more than when we came into office in 2010 on supporting people with long-term health conditions and disabilities. This represents a record high of 6% of Government spending, and we are committed to seeing that rise in every single year for the rest of this Parliament.
On the specific point of appeals, we know that the vast majority of successful appeals are because of additional written and oral evidence, but we recognise that the independent appeal process is too long and that it adds anxiety for claimants who are in too many cases having those decisions changed over. We are therefore determined to improve the mandatory reconsideration stage so that we can proactively contact claimants to get that additional written and oral evidence at that point. We have already piloted this in all the PIP mandatory reconsideration assessment centres, and that has been so encouragingly positive that we will do the same with the work capability assessment mandatory reconsiderations. This is a really important area of work, and we are determined to get it right for all claimants as quickly as possible.

Maria Miller: Many people will be unaware of the way in which PIP supports people who have mental health conditions far better than the predecessor benefit, disability living allowance, but mental health conditions can fluctuate and people can find it very difficult to get the right support and advice. How is my hon. Friend ensuring that PIP best  supports those people, particularly in finding their way through what can be a very complicated and difficult application system?

Justin Tomlinson: My right hon. Friend raises the really powerful point that we collectively need to do more to support claimants with mental health conditions. This is why we now have mental health champions in all the PIP assessments, and we are putting videos online so that people can see what to expect. We encourage claimants to bring a trusted third party—family, friends or a support worker—with them during the process, and we are working with the Department of Health and Social Care to identify ways to get hold of the crucial medical evidence that can improve the decision making at the first time of asking.

Frank Field: Will the Minister please answer the question that the hon. Member for Glasgow South West (Chris Stephens) asked him at the beginning: how many more claimants will now be eligible for PIP who previously were not? Also, will he again clarify a commitment that he will look at all those claimants who have had their PIP application turned down, to see whether they are now eligible under the new rules?

Justin Tomlinson: We must consider the detail of the judgment and how it needs to be implemented before we can estimate how many people will be affected, but we will look back at cases. We are committed to engaging with stakeholders and disabled people, utilising their expertise, to ensure that the people who should receive support get it fully, fairly and as quickly as possible.

Christine Jardine: The Liberal Democrats welcome the Supreme Court judgment, and I welcome much of what the Minister has said today about making things easier and more appropriate. However, does he accept that, as has already been mentioned, mental health assessments bring with them a particularly difficult set of circumstances? People’s conditions may fluctuate, and assessments affect individuals in different ways, so will he consider, yet again, bringing assessments back in-house and having specialists who deal specifically with mental health cases to ensure that individuals get not only a mental health champion, but an appropriate champion with knowledge of their particular condition?

Justin Tomlinson: I understand the thrust of the hon. Lady’s point, and I know that she works hard in this area. As I have said, our collective understanding is getting better, and we are working with stakeholders—people with real frontline experience—to help shape our training. All the assessors—trained health professionals—have people behind them who are experts in all conditions, not just mental health. Remember, many claimants have a menu of health conditions to be navigated. Where an assessor feels that they need additional support, they will get it from those experts before the assessment and while writing the report afterwards.

Debbie Abrahams: To be dragged to the courts yet again in relation to PIP and the totally inadequate support that it provides to disabled people is a shame on this Government. According to Mind, two thirds of people on DLA for  mental health conditions have had their PIP refused or reduced, which is not just not good enough. On top of that, 60 disabled people a month—a month—die after being refused PIP. To say that PIP is an okay support system for the most vulnerable people in this country is an absolute disgrace, so will the Minister write to me and answer the questions that I put to him in my letter of over two months ago?

Justin Tomlinson: I remind the hon. Lady that the Government took this case to the Supreme Court because we wanted to get clarity on this important issue. I also remind her that, under DLA, only 6% of claimants with a mental health condition got access to the highest rate of support. Under PIP, 33% of claimants are getting that support—more than five times higher than under DLA. We are doing everything we can to support people, and we are continuing to work with stakeholders and disabled people to ensure that the process continues to improve. I am proud that this Government are spending a record amount of money on supporting the most vulnerable people in society, something which the Opposition Members continue to vote against at each Budget.

Heidi Allen: The judgment is welcome, of course, because it will provide more support to people with mental health conditions, but it does prompt a question, regardless of who brought the case, about whether the PIP and ESA assessment processes still contain significant flaws. I was under the impression that the Government were looking at the processes, potentially bringing them back in-house, and I agree with my hon. Friend the Member for Edinburgh West (Christine Jardine) that there should be more specific assessments for people with certain types of health conditions. Why are the contracts with Atos and Capita being extended for another two years when they are not meeting their targets?

Justin Tomlinson: I thank the hon. Lady for her question. The key thing is that we will continue to engage with stakeholders and disabled people and be held to account by the Select Committee on Work and Pensions, of which the hon. Lady is an active member. We will continue to make improvements, which is why increasing amounts of money are rightly being spent on vulnerable people in society. The Secretary of State is personally committed to improving the process, and we will do all that we can to do so.

Paul Sweeney: The change from DLA to PIP has meant that my constituents have lost £2 million collectively—[Interruption.] That is a matter of fact, so I do not know why the Secretary of State is shaking his head. There is clearly a lot of despair behind that figure, and the recent judgment clearly proves that the situation is unsound. What is the Secretary of State going to do to fix it?

Justin Tomlinson: I thank the hon. Gentleman for elevating me to Secretary of State. I am just a Minister of State, but he is very kind. To be clear, 33% of people with a mental health condition will now access the highest rate of support under PIP, compared with just 6% under the legacy benefit. That is significant progress,  but we are committed to work with stakeholders and disabled people to continue the improvements that we are proud to be making.

Alex Sobel: Just last week, I had a constituent in my surgery who had not been awarded points in their PIP assessment for which I could clearly see that they were eligible. After the ruling, and considering that people have hidden and fluctuating conditions, what can my constituent now expect?

Justin Tomlinson: As I have set out, we will be looking carefully at the judgment, but the hon. Gentleman highlights something. As constituency MPs, we all have cases in which it is clear that, with additional written and oral evidence, a different decision could come about. That is why it is right—it is a departmental priority—to improve the mandatory reconsideration stage, so that more people can get the correct decision much quicker, without the long independent appeal process.

Alison Thewliss: There is a letter in the post to the Minister about this case, but I do not know whether he will be there to receive it, so I thought that I would ask about it here. My constituent has a long-standing diagnosis of Asperger’s, but her PIP assessor ignored the detailed medical evidence that she had provided and performed a five-minute mental state test involving taking 25p away from £1 and spelling the word “world” backwards. Her decision letter stated that she had
“no cognitive sensory impairment diagnosed”
and
“no evidence of a cognitive impairment”.
Surely constituents should not have to come to their MP to get such evident mistakes overturned. The Minister should be getting things right first time, rather than going for mandatory reconsiderations.

Justin Tomlinson: I have gone from being the Secretary of State to potentially not having a job in the next couple of days in the space of one question, but I will look at that letter carefully. I actually agree with the hon. Lady’s point that we want the right decision the first time. We want claimants to be able to access the crucial medical evidence that can assist with assessments. Assessments are right more often than not, and only a small percentage of claims ultimately need to be appealed, but we need to learn lessons wherever there are mistakes, and I will take that case seriously.

Ruth George: I also welcome the ruling, but it is important not just that we get rulings, but that people on PIP get the support that they deserve. I was concerned by the release of figures a couple of weeks ago showing that the Department’s own equality impact assessment expected 14% of the 1.6 million people on PIP who were reviewed after previous court rulings to get an additional award, but just 0.8% of people reviewed have actually received an increase in their entitlement. Will the Minister commit to an urgent audit of what is going on in those reviews to ensure that people affected by this case do not see their awards quashed yet again?

Justin Tomlinson: The hon. Lady refers to the mental health estimates, which were done before the final guidance was implemented. We have consulted with Mind and  other key stakeholders on the revised guidance, and we will continue to ensure that those who are entitled to additional support get it as quickly as possible. We are on track to complete that work by next year, as initially set out.

Clive Efford: We all have casework in our surgeries involving people suffering from mental health issues who have been denied PIP or have had it taken away from them, but the situation goes beyond that. I have a profoundly deaf constituent who was transferred from DLA to PIP, but they were then denied PIP. Other people with chronic illnesses have failed to score enough points through the question and answer system. Will the Minister take on board the fact that other people in the system will be suffering similarly? We need a fundamental review to ensure that those people do not suffer in the way that they are currently.

Justin Tomlinson: We have made a real commitment, and we work closely with stakeholders representing a huge variety of disability and health conditions, empowering them to challenge, to make suggestions, and to work with our teams to help shape the training guidance. That is why an increasing amount of money is being spent each year on supporting people with disabilities and long-term health conditions. As I said, at £55 billion a year, spending is up £10 billion since we came to office. That is a record high, and it will continue to increase as we work, listen and engage with the people who have frontline experience, which the Government have committed to do.

Alan Brown: I have a constituent who is rebuilding his life after spending some time in jail. His mental health condition means that he has communication issues and that crowds are a problem for him, which makes travel on public transport more problematic. All of that makes it difficult for him to maintain family contact and access the necessary support groups. He was denied PIP despite my office sending supporting letters and trying to help him hit the PIP descriptors. What changes will the Government make to the system so that my constituent will get the support that he deserves, as in the Supreme Court ruling, and be able to go forward and fully integrate into society?

Justin Tomlinson: I would be happy to look at that specific case. On the broader point of supporting people transitioning from prison back into society, I pay tribute to the Under-Secretary of State for Work and Pensions, my hon. Friend the Member for Colchester (Will Quince), who has responsibility for family support. He has been working with the Minister of State, Ministry of Justice, my hon. and learned Friend the Member for South Swindon (Robert Buckland), the prisons Minister, to make sure it is joined up. We have had successful trials to make sure that work coaches go into prison in advance of a person’s leaving, as it is key that those who need the support can access it as quickly and as smoothly as possible. The case raised by the hon. Member for Kilmarnock and Loudoun (Alan Brown) highlights why that is so important.

DECRIMINALISATION OF ABORTION

Diana R. Johnson: (Urgent Question): To ask the Home Secretary to make a statement on the repeal of sections 58 and 59 of the Offences Against the Person Act 1861 in England and Wales, in consequence of the decriminalisation of abortion in Northern Ireland.

Jackie Doyle-Price: I have been asked to answer this question. As with other matters of conscience, abortion is an issue on which the Government adopt a neutral stance and allow Members to vote according to their moral, ethical or religious beliefs. As the Secretary of State for Health and Social Care has responsibility for abortion policy, I am an instrument of the House in that regard and I will discharge the instructions of the House in the best interests of patient safety.
The Government have a duty to see that the provisions of the Abortion Act 1967 are properly applied until, and unless, Parliament chooses further to amend that law. The hon. Lady will be aware that the Abortion Act—the legislation affecting England and Wales—is an amendment to the Offences Against the Person Act 1861. Notwithstanding the issues in Northern Ireland, the Government currently have no plans to amend sections 58 and 59 of the 1861 Act in England and Wales.
Abortion is an extremely sensitive issue, and there are very strongly held views on all sides of the debate. Given this, any significant changes to the law require careful consideration and full consultation with the medical profession and others. Moreover, it is right that MPs and peers—or the devolved legislatures, as the case may be—have adequate opportunity to scrutinise any legislation fully. The Joint Committee on the draft Domestic Abuse Bill has also made it clear that abortion is not a matter for the Domestic Abuse Bill, which the House will consider shortly.
The question of potential reform to Northern Ireland’s abortion laws, through the Northern Ireland (Executive Formation) Bill if no restored Government are in place, should not be cause to reform the system in England and Wales. Abortion in England and Wales is already accessible and serves the needs of women seeking to access such services. The law also provides protection for the medical profession in carrying out its functions and duty of care to women.
As abortion is a devolved matter in Northern Ireland, the Government’s preference remains that a restored Executive and a functioning Assembly take forward any reforms to the law and policy on this issue. It is our hope that devolved government will be restored at the earliest opportunity through the current talks process.
We do, however, recognise the strength of feeling expressed by the House in the amendments to the Northern Ireland (Executive Formation) Bill, which place a duty on the Government to make regulations to reform Northern Ireland’s abortion laws if there is no restored Executive by 21 October 2019. The Government will work expeditiously to take forward this work,  should that duty come into effect in the absence of devolved government.
The Government will also work with service providers to ensure that, in the meantime, the scheme provided in England for women from Northern Ireland continues to be fully accessible and that appropriate information is provided to those seeking to access those services. It remains my priority to provide safe access to abortion services under the law, as set by Parliament.
I appreciate this is an emotive issue, on which there are strongly held views, and I am sure it is something we will continue to debate in Parliament over the coming months, but I end by reminding the House that, over the past 50 years, the Abortion Act has ensured that women have access to legal safe abortion, which has contributed to a significant reduction in maternal mortality and has helped to empower women to make informed choices at what can be a very sensitive and difficult time in their lives.

Diana R. Johnson: I thank the Minister for her response, although it is a very disappointing response that does not address the subject of my question: England and Wales. I am also disappointed that we do not have a Minister from the Home Office, because this is a matter of criminal law.
The Northern Ireland (Executive Formation) Bill, which repeals sections 58 and 59 of the Offences Against the Person Act 1861 in Northern Ireland, completed its parliamentary passage yesterday, but those sections still apply in England and Wales, meaning that any woman who ends a pregnancy without the permission of two doctors faces up to life imprisonment. That includes women who obtain pills online, and they might be women in abusive, coercive or controlling relationships, women living in rural areas and women who have childcare responsibilities who cannot access services in clinics.
Despite legal access to abortion in Great Britain, two women a day seek online help on abortion from Women on Web. The Medicines and Healthcare Products Regulatory Agency, the medicines watchdog, has over three years seized almost 10,000 sets of abortion pills headed to British addresses.
The House will be pleased to know that there are no arguments about jurisdiction on repealing these provisions for England and Wales, and we are the competent body to do so. We have voted to decriminalise abortion on two recent occasions, 13 March 2017 and 23 October 2018, which alongside last week’s vote on the Northern Ireland (Executive Formation) Bill clearly shows the will of this House that abortion should no longer be part of our criminal law but should be a regulated health decision between a woman and her doctor. I must stress again that decriminalisation does not mean deregulation, and a whole range of legal and professional regulation would still apply, just as it does to other healthcare procedures.
The situation in which we now find ourselves is unjust, irrational and confusing. The British Pregnancy Advisory Service released polling this morning showing that only 14% of people are aware of the current law and that 65% of British adults and 70% of women do not support the current criminal sanction.
Decriminalisation is supported by the Royal College of Obstetricians and Gynaecologists, the Royal College of General Practitioners, the Royal College of Midwives,   the British Medical Association and the Royal College of Nursing, so I ask the Minister again. When will the Government act to repeal sections 58 and 59 of the Offences Against the Person Act, and will there be a moratorium on any prosecutions under these sections in the meantime?

Jackie Doyle-Price: I know I will disappoint the hon. Lady, and I know she has been a passionate campaigner on these issues for many years, with the welfare of women at her heart. I answer this question with great respect for her desire, but it remains the case that the Government are not minded to repeal the provisions of the 1861 Act in England and Wales, recognising that we have an Abortion Act that provides for access to abortion services.
From the perspective of the safety of women accessing abortion services, the issues raised by the hon. Lady do concern me. It is not good for the welfare of women that pills are being accessed online. I also observe that the Abortion Act is more than 50 years old and was the product of a very different time. Abortions were then entirely surgical, and the medical abortions to which we now have access are clearly far safer.
This is very much a personal view, and I am not speaking for the Government in advancing this view, but I think that making provision for early abortion and for recognising medical abortion in law will get us much further. We need to make sure we have a safe regime that enables women to access abortion services as safely as possible.

Tim Loughton: I supported decriminalisation, I supported the regularising of the abortion law in Northern Ireland last week, and on Friday I shall visit my local BPAS clinic. But changing the law is only part of it. Last year, I was out with an ambulance crew and we were called out to a woman who had been at an abortion clinic and taken the pills. She was bleeding heavily and had been taken very ill, and there was no out-of-hours service—this was on a Friday evening. Does the Minister agree, particularly in respect of the availability of do-it-yourself pills on the internet, that it is absolutely essential that, at a very difficult time for a woman who has taken that decision, the ongoing support is there 24 hours a day, seven days a week?

Jackie Doyle-Price: My hon. Friend reminds us that this is not always an easy process for women to go through. As with any medical procedure, full consent must be given, based on full information. As long as pills can be accessed via the internet rather than via medical professionals, it is clearly more likely that women will not be informed of the risks of taking the pills. Any medication can have risks and consequences, and women need to be fully advised so that they can manage what they are going through.

Sharon Hodgson: Thank you, Mr Speaker, for granting this urgent question. I thank my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) for and congratulate her on securing this urgent question, and thank her for her tireless campaigning on this issue. I share her disappointment that no Home Office Minister  was available to respond to this urgent question; waiting for a call is obviously more important. I thank the British Pregnancy Advisory Service for its excellent work on this issue, and for its new campaign, launched today, called #PunishedForPills.
Following the passage yesterday of the Northern Ireland (Executive Formation) Bill, we find ourselves with a discrepancy across the UK when it comes to abortion. As we have heard, sections 58 and 59 of the Offences Against the Person Act 1861 no longer apply in Northern Ireland, but still apply in England and Wales, which means that if a woman does not seek the permission of two doctors before having an abortion, she could face up to life imprisonment in Britain, but not in Northern Ireland. The same goes for women who access abortion pills online. There are a whole host of reasons why women may do that, including not being able to get an appointment at a clinic, which now happens more and more often; not having childcare; living in a rural area; or being in an abusive relationship. Although women in Northern Ireland will no longer be persecuted for accessing abortion pills, the same cannot be said for women in Britain. I know this issue does not fall under the Minister’s brief, but will she ensure that abortion will be decriminalised, but not deregulated, throughout the UK? That would increase access to and the safety of abortions for women throughout the UK.
No one takes abortion lightly—this is a very sensitive issue—but I am sure that we in the House can all agree that women deserve access to safe and legal health procedures, and that includes abortion. A woman’s right to choose is a human rights matter. We need to seize on the momentum of the great result in the Republic of Ireland and deliver equality of rights for women throughout the UK and equality of resources across the whole NHS. The Government need to make this a landmark year in which women’s reproductive rights are fully respected and realised. That is why I call on the Government to repeal sections 58 and 59 today, to make abortion rights equal throughout the UK.

Jackie Doyle-Price: I thank the hon. Lady for the characteristically constructive spirit in which she has engaged with this issue. The nub of the point she makes is that decriminalisation must not be met with deregulation. Whatever we do, we must make sure that in repealing those sections of the 1861 Act—if that is what Parliament chooses to do—the regime that replaces it must not only guarantee the rights of women to take decisions for themselves but protect them and keep them safe. That is my priority in addressing this issue.

Desmond Swayne: My hon. Friend is aware—isn’t she?—that any proposal for appeal will be resisted as passionately in the country and on the Government Back Benches as it has just been advocated by those on the Opposition Benches?

Jackie Doyle-Price: I am very aware that this issue rouses passions on both sides of the argument, which is why I reassure the House that, from my perspective, I just want to make sure that I deliver Parliament’s instructions in a way that is safe. I should add that perhaps the way in which both sides of the argument  have been debated in the House has not led to good law-making, because it has meant that the law has not been revisited in 50 years and has not kept pace with medical advancement.

Stella Creasy: The Minister herself just made exactly the case that my good and hon. Friend the Member for Kingston upon Hull North (Diana Johnson) made so powerfully about the need to make sure that the law works for the 21st century. The votes we had in this place in the past two weeks were to recognise that human rights are not a devolved matter and should be available to every UK citizen. Although I enjoy the irony that potentially we could end up with the most progressive abortion laws in Northern Ireland, my constituents in Walthamstow and, indeed, all our constituents in England and Wales deserve to be treated equally as an adult, able to make their own choices.
In reading out what I believe someone had given to her as the Government’s stated position on this legislation, which puts having an abortion on the same level as child stealing and using gunpowder to blow up a building, the Minister said that there would need to be a consultation with medical bodies “and others”. Will she tell us who the others are and why, when it comes to something medical, it is only women who seem to have non-medical professionals getting involved in deciding what their rights to access treatment might be?

Jackie Doyle-Price: As with any consultation, “others” would include all members of the public, and everyone here is a representative of members of the public. There are a number of ways that we can get to the outcome of legislation fit for the 21st century. It is the Government’s position that the simple repeal of those two aspects of the 1861 Act is not sufficient to guarantee safe legislation for women in this country. We have an Abortion Act that empowers women to take decisions themselves. Again, I come back to the fact that this is an issue of conscience. As Minister, I will implement the law as decided by Parliament.

Kate Green: I have great respect for the Minister, but I do not think there is any case at all for inviting amateurs to comment on what should be medical, clinical assessments. The criminal law always bears down most harshly on the most vulnerable and marginalised women: very young women, those with literacy or learning difficulties, those with poor language skills and those who may be in an abusive relationship. Will the Minister therefore consider again her stance—the Government’s stance—on the impact of encompassing this offence in our criminal law, and look at steps that can be taken urgently to repeal it?

Jackie Doyle-Price: The specific offences to which the hon. Lady refers are a matter for the Home Office. The Government’s position is that they should not be repealed for England and Wales at this point. I absolutely understand the issue she raises with regard to the most vulnerable, and she and I have had discussions on that basis, but that is also a reason why simple repeal is not necessarily the best tool. To have a safe regime in place is also to protect exactly the people she identified. As I have said, from a personal perspective I do not think   that the current law is in any way satisfactory, and I hope that in future we can have sensible discussions about how we might modernise it.

Karin Smyth: In my role as a member of the British-Irish Parliamentary Assembly, the committee on which I serve, which is chaired by the noble Lord Dubs, has for the past two years been looking at abortion policy across the whole of Ireland and Britain. Our report should have been available already, but there was some disagreement as to its final content. We will be updating it, hopefully for publishing in October. It would be helpful to discuss that report with the Government. As well as online medication, we have found other particularly concerning issues: we need to remember that there are no borders for healthcare for women across these islands, and there are no borders for how women across these islands will continue to support each other. We want to see more equality. Of real concern are the often very traumatic cases of late terminations. The workforce across our islands are not skilled—there are not enough of them and there are not enough good-quality skills. Does the Minister agree that the Government should at least look into those points regarding workforce?

Jackie Doyle-Price: Yes, absolutely. I would be delighted to meet the hon. Lady about her report. That there is difficulty in getting agreement comes as no surprise to me but, given the intentions of the people behind it, having that discussion would be useful. Yes, I have heard concerns expressed about skills levels, in particular to perform late-stage terminations, which are incredibly dangerous, as she is aware. I will endeavour to take that forward with the relevant bodies.

Heidi Allen: I sense that the Minister is genuinely trying to help. There is some irony in that we have been trying for so long to amend legislation in Northern Ireland to reflect what we have here, but now it has gone the other way—in the absence of any Executive, with the repeal of sections 58 and 59, Northern Ireland will in fact have more modernised legislation than we have. May I ask her explicitly what she thinks—personally, I suspect—would be the most effective tool to modernise abortion law right across the UK, which the majority of Members want?

Jackie Doyle-Price: That is a difficult question to answer given that the matter is now completely devolved. In respect of England and Wales, I think that the most effective method would be to revisit the Abortion Act, which is itself an amendment to the Offences Against the Person Act providing an exemption for women making that choice in those circumstances. My personal view—the Government do not have a view on such matters of conscience—is that, after 50 years, the Abortion Act does not reflect medical practice today, and therefore restricts the choices of women and their ability to exercise those choices in the safest way.

Liz McInnes: Other jurisdictions in Canada and Australia have already removed abortion from the criminal law without any increase in the rate of abortion or in late terminations. The Minister  cloaks the issue in words such as “emotive” and “sensitive”, but this is actually a legal issue, and women in England and Wales deserve the same protection now afforded to women in Northern Ireland. Given that this is a legal issue, when will we get an answer from the Home Office, rather than the buck being passed to the Health Minister?

Jackie Doyle-Price: At the risk of being flippant, obviously I can only relay the policy given to me by the Home Office. I can give the hon. Lady my views on how we best keep patients safe, but clearly, when it comes down to it, how Parliament decides to manage such issues is a matter for Parliament; the Government and I as a Minister will do as instructed.

Jo Stevens: Will the Minister give us an example of any other medical procedure or treatment that is a human right that is criminalised by the law in England and Wales?

Jackie Doyle-Price: We need to look at exactly what the Offences Against the Person Act says, which is not in the context of a medical procedure. That is why we have the Abortion Act, which provides for a specific exemption by treating abortion as a medical procedure. The Offences Against the Person Act is in effect about foeticide; the Abortion Act amends that to decriminalise women seeking an abortion. That is the difference. If we make it about the Offences Against the Person Act, we are missing the point about England and Wales.

BILLS PRESENTED

Low Carbon Domestic Heating Bill

Presentation and First Reading (Standing Order No. 57)
Sir David Amess, supported by Ian Austin, Mr Adrian Bailey, Sir Graham Brady, Tom Brake, Maria Caulfield, Mr Roger Godsiff, Zac Goldsmith, John Grogan, Tim Loughton, Sarah Newton and Alex Sobel, presented a Bill to make provision about low carbon domestic heating systems.
Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 427).

Asylum Seekers (Accommodation Eviction Procedures) Bill

Presentation and First Reading (Standing Order No. 57)
Chris Stephens presented a Bill to make provision for asylum seekers to challenge the proportionality of a proposed eviction from accommodation before an independent court or tribunal; to establish asylum seeker accommodation eviction procedures for public authorities; and for connected purposes.
Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 428).

John Bercow: Suggestive of a busy “tomorrow”—we shall await the development of events. Meanwhile, we have an item of considerable parliamentary excitement, namely the ten-minute rule motion, which the hon. Member for East Worthing and Shoreham (Tim Loughton) has been patiently waiting to move.

TIBET (RECIPROCAL ACCESS)

Motion for leave to bring in a Bill (Standing Order No. 23)

Tim Loughton: I beg to move,
That leave be given to bring in a Bill to require the Secretary of State to report annually on restrictions on access by UK nationals to Tibet in comparison with other regions of China; to make provision to deny persons involved in imposing such restrictions permission to enter the UK; and for connected purposes.
In May, in my role as chair of the all-party group for Tibet, I attended the seventh world parliamentary convention on Tibet in Riga, Latvia, together with the hon. Member for Dundee West (Chris Law), who I am delighted is in the Chamber today. We joined parliamentarians from around the world, representatives of the Tibetan Parliament in exile based in Dharamshala, and His Excellency Lobsang Sangay, the Sikyong or President of the Central Tibetan Administration since 2012. We were pleased to receive the Sikyong in this place, and that he met you, Mr Speaker, just a few weeks ago.
At the convention, we discussed continued human rights abuses of Tibetans at the hands of Chinese security forces; the routine intimidation of Tibetans, their supporters and the Dalai Lama himself around the world; the assaults on the Tibetan language, and the culture, religious practices and way of life of Tibetans generally; and the continued population transfer of Chinese into Tibet to dilute and smother further the Tibetan identity. We also debated at length the environmental degradation being waged on the Tibetan plateau, which has led to an unprecedented number of natural disasters, caused by the impact of excessive and unsustainable mineral extraction and dam construction in an area whose rivers service some 40% of the world’s population; as well as the accumulation of waste and the dumping of toxic waste on the plateau and in Tibet’s waters. We discussed, too, the tragic self-immolation of more than 150 Tibetans in protest against Chinese persecution in Tibet, and the continued human rights abuses generally.
We all signed up to the Riga declaration, which requests China
“give unimpeded access to Tibet to foreign journalists, scholars and researchers, diplomats and other foreign citizens, including those of Tibetan origin.
To cease its policies and practices that harm the natural environment of the Tibetan Plateau.
And to resume the dialogue with envoys of His Holiness the Dalai Lama without preconditions”,
because the Tibetan struggle has always been a peaceful one.
A few days before the convention, I received a phone call from a senior official at the Chinese embassy in London, strongly suggesting that I should not be going to Riga, that I should not be consorting with such people and that I should rethink my plans, because everything is fine in Tibet, and that is plain for all to see. Basically, I was told, “You don’t want to go Riga, Mr Loughton, do you?” I responded politely that his entreaties had made me even more determined to attend  the convention and I asked why, rather than intimidating parliamentarians, the Chinese Government do not sit down to talk to us.
I again invited the Chinese ambassador to attend a meeting of the all-party group for Tibet and indicated that a group of us would be delighted to be hosted in Tibet so that the Chinese Government can show us at first hand how everything in Tibet is just fine. Subsequently, I wrote twice to His Excellency Liu Xiaoming, the Chinese ambassador in London, but I await a reply, even though the ambassador has found time to attend numerous other all-party group meetings in this place and various other events in recent months.
We should not be surprised, however, by that behaviour by the Chinese. Their record on human rights, cultural tolerance and the environment is deplorable, which is why they do not want people from outside finding out what goes on in the inside. Foreigners including British and EU citizens, and Americans require a number of special authorisations and permits in addition to a Chinese visa to enter the Tibet autonomous region, which spans about half of Tibet. For those who do get in, a Government-appointed guide must accompany them, and during politically sensitive periods the region is completely closed to foreigners. Such closures have occurred regularly since a wave of mostly peaceful protest swept across the Tibetan plateau ahead of the 2008 Beijing Olympics.
Foreign diplomats, parliamentarians, journalists and even UN officials are almost always denied visits to the region, other than on rare official tours carefully orchestrated by the Chinese authorities. At the same time, Tibetans are regularly prevented from travelling outside China, and those passing information abroad are punished severely. A prominent example is Tashi Wangchuk, a young language rights advocate who last year was sentenced to five years in prison, just for giving an interview to The New York Times about his efforts to protect Tibetans’ mother tongue. The UK ambassador in Beijing has not been able to visit the Tibet autonomous region since 2017, and is still waiting for permission to travel. Trips by officials and tourists are always closely managed, and travel permits are often withdrawn at short notice.
Sadly, such restrictions are even harsher for European citizens of Tibetan heritage, many of whom are refugees who escaped from Tibet and are specifically targeted by and discriminated against by Chinese embassies and consulates when they apply for a travel permit. That cruelly prevents many of them being able to see their families, from whom in many cases they have been separated for a long time.
Recently we have seen the latest attempts at repression by the Chinese authorities in Hong Kong, and the brave resistance of millions of Hong Kong citizens. Less graphically we have been given limited access to the appalling abuses in the Xinjiang region of China, where more than 1 million Uighurs, Kazakhs and other primarily Muslim minorities are detained in concentration camps that are cynically dressed up as re-education schools. Families are being split up and thousands of children are being taken into state care. But we must not be distracted from the long-term protracted suffering of the Tibetan people; in the 60 years since the occupation and invasion, more than 1 million Tibetans have lost and continue to lose their lives.
We can no longer sit idly by. All attempts to shed light on human rights abuses through the universal periodic review of the UN Human Rights Council have been snubbed, and continue unabated and largely in secret. The Foreign Press Association has reported that it is easier for Beijing-based journalists to visit North Korea than to visit Tibet.
Chinese authorities take advantage of our freedoms in the west to travel freely and spread their propaganda, but routinely refuse to reciprocate. That must stop. Recognising this, in December 2018 the United States adopted the Reciprocal Access to Tibet Act, which promotes access to Tibetan areas for American diplomats, journalists and ordinary citizens—just as their Chinese counterparts enjoy in the US. Despite Chinese denunciation of this law, the legislation already appears to have made an impact, as Chinese state media are now reporting that Beijing has decided to adopt a faster process for foreign tourists to receive permits to enter Tibet. This landmark Act had cross-party support and was unanimously approved by the United States Senate Committee on Foreign Relations in December. It was sponsored by Republican Senator Rubio and Democrat Senator Bob Menendez, and even President Trump welcomed it.
My Bill mirrors the US Act. I will shortly be publishing the draft Bill, replacing references to “US” with “UK” and “State Department” with “Foreign Office”, and making other appropriate adjustments. It will also include a recommendation for the UK Government formally to request that the UN Special Committee on Decolonization considers Tibet. Given that China is part of that committee, it would therefore need to recuse itself. I hope that request will be taken seriously.
My Bill requires the Foreign Office to report to Parliament annually regarding the level of access that Chinese authorities grant to UK diplomats, journalists and tourists to Tibetan areas in China. Such assessment shall include: a comparison with the level of access granted to other areas of China; a comparison between the levels of access granted to Tibetan and non-Tibetan areas in relevant provinces; a comparison of the level of access in the reporting year and the previous year; and a description of the measures that impede the freedom to travel in Tibetan areas.
Under this legislation, no individual who is substantially involved in the formulation or execution of policies related to access for foreigners to Tibetan areas may enter the United Kingdom if: the requirement that foreigners must receive official permission to enter the Tibet autonomous region remains in effect or has been replaced by a similar regulation that also requires foreigners to gain a level of permission to enter the Tibet autonomous region that is not required for other provinces; and travel restrictions on United Kingdom diplomats, officials, journalists and citizens to Tibet autonomous areas in Sichuan, Qinghai, Yunnan and Gansu provinces—I apologise to Hansard—are greater than travel restrictions to other areas.
The Bill will also require the Foreign Office to report to Parliament annually, identifying individuals who were blocked from United Kingdom entry during the preceding year and a list of Chinese officials who are substantially involved in the formulation or execution of policies to restrict the access of UK diplomats, journalists and citizens to Tibetan areas.
The Bill mirrors the legislation that has already been passed unanimously by the US Congress. It is time for us, in Europe and the United Kingdom, to take a similar stand to show categorically to China that its continued abuses in Tibet do not go unnoticed or unappreciated, and that we will tolerate them no more.
I am pleased to report that the Bill is co-sponsored by Members representing all the main political parties who have more than one Member in this House—demonstrating the widespread sense of outrage at what China continues to get away with in its continued persecution of Tibet and Tibetans the world over. I commend this Bill to the House.
Question put and agreed to.
Ordered,
That Tim Loughton, Chris Law, Sir Peter Bottomley, Jim Shannon, Kerry McCarthy, Christine Jardine, Jonathan Edwards, Mike Gapes, Maria Caulfield, Catherine West, Fiona Bruce and Marion Fellows present the Bill.
Tim Loughton accordingly presented the Bill.
Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 429).

EXITING THE EUROPEAN UNION (TRANSPORT)

Michael Ellis: I beg to move,
That the draft Cableway Installations (Amendment) (EU Exit) Regulations 2019, which were laid before this House on 2 July, be approved.
These regulations will be needed in the event that the UK leaves the EU without an agreement. They are being made under powers conferred by the European Union (Withdrawal) Act 2018, and will give clarity and certainty to industry by fixing deficiencies that will arise in two pieces of legislation when the UK leaves the EU: namely, EU regulation 2016/424, which is a directly applicable EU regulation; and the Cableway Installations Regulations 2018, which implemented the EU regulation.
It may be helpful if I provide some background. Cableways are a mixture of funicular railways and aerial transport systems such as ski lifts for the transport of passengers. They are important for tourism and communities, and we support their continued success. The majority are in snow sports resorts in Scotland, but they also include the Emirates line in London. Those that entered into service before 1 January 1986 are classed as historical, cultural or heritage installations—for example, the Great Orme Tramway and the Babbacombe Cliff Railway—and are excluded from the scope of the 2018 regulations and the EU regulation.
The EU regulation is in part directly applicable in the UK, so it forms part of domestic law. The 2018 regulations supplement the EU regulation where further detail is required—for example, on the authorisation process for the construction or modification of and entry into service of cableway installations, and in providing for the enforcement of the regulatory framework. The EU regulation and the 2018 regulations ensure conformity of standards of cableway components across the EU; require the Secretary of State to notify the EU Commission of the notified body responsible for carrying out conformity assessments to ensure that cableway systems, subsystems and their components meet EU standards; and require the Secretary of State to set rules on the design, construction and entry into service of new cableway installations.
The 2018 regulations and the EU regulation contain a number of elements that will be inappropriate after the UK leaves the European Union. If left unamended, these would render the 2018 regulations and the EU regulation deficient in certain respects post-exit. This instrument will ensure that the legislation on cableway installations will continue to function correctly in the future—as I am sure the House would approve—providing clarity and certainty to providers.
Before I turn to what the instrument does, let me highlight the fact that it has been developed in close co-operation with the industry and the Health and Safety Executive. We have also consulted the Scottish Government; Ski Scotland, which represents the snow sports industry; and Transport for London, given its particular interest in this area. No major concerns were raised by any of those organisations regarding the approach being adopted in this instrument.
The current legislative framework gives cableway operators reassurance that the components used in new cableways, or for maintaining or repairing existing cableways,  are safe and that they comply with EU standards. Given the reassurance provided by the current standards, we have no current plans to diverge from them. However, if the UK ever wanted to diverge from EU-harmonised standards, the instrument contains a power for the Secretary of State to designate standards in future. The instrument enables the Secretary of State to designate standards by means of a technical specification for cableways installations, their systems or subsystems, and publish that standard in a manner which he considers appropriate.

Tim Loughton: I am listening intently to the Minister’s remarks about this extremely interesting and important SI that we are about to pass. Has he considered the impact of climate change on the use of cableways in, particularly, Scottish ski resorts, which are probably the biggest users of such technology? These regulations may be completely redundant in a few years’ time if we have no snow and no ski resorts because of climate change.

Michael Ellis: I am so grateful to my hon. Friend for raising that point. Of course, everything that I do in the Department for Transport considers these important issues of climate change, and my officials are very alive to this issue.

Chris Bryant: Very frequently in the measure, the words “notified body” are replaced with “approved body”. Why is that so common a feature?

Michael Ellis: I am going to come to that right now.

Jim Cunningham: Elaborating on the point made by the hon. Member for East Worthing and Shoreham (Tim Loughton), one can actually have artificial snow ski resorts.

Michael Ellis: Yes, indeed, but even then, one would still need a cableway in order to reach the required area.
The use of this power would be subject to full consultation with the industry and the appropriate technical and safety bodies, such as the Health and Safety Executive.
As the hon. Member for Rhondda (Chris Bryant) mentioned, this instrument replaces the definition of “notified body” with “approved body”. This will allow the Secretary of State to approve bodies to carry out cableways conformity assessments. It should be noted that currently there are no such approved bodies in the UK, so until such time as a body is approved, we will continue to recognise EU-notified bodies. I hope that is clear.

John Redwood: When my hon. Friend was considering rolling over these standards, did he look at American and other world standards compared with European ones? Were they higher or lower, and might we lose out if we adopt only European standards in terms of imports?

Michael Ellis: Of course we keep under advisement all the safety standards. The officials in my Department are constantly looking at issues of safety. Historical and heritage cableway apparatus, for example, is subject to different regulations under the Health and Safety at  Work etc. Act 1974. General safety is of paramount importance, and we always look at international comparisons.
All the other changes being made by the instrument are minor and technical in nature—for example, removing references to member states and changing the terminology where applicable.
In summary, cableways are important to communities across the UK and are part of the economy in many areas. These draft regulations will give industry the clarity and certainty it needs that the current standards will continue to apply if the UK leaves the EU without an agreement.

Rachael Maskell: I rise in support of the Cableway Installations (Amendment) (EU Exit) Regulations 2019. These regulations would come into force if the UK were to leave the EU without a deal, which would clearly be catastrophic for the economy and our future.
However, why are we debating these regulations only now, nearly four months after the UK was due to leave the EU? If we had left with no deal at that time, what would have happened to the cableway sector and its regulation? It seems extraordinary that the Government are only now discovering regulations that need to be debated. How many more are at the back of the cupboard in the Minister’s Department and are yet to come to the Floor of the House? That is especially important as safety is paramount in these regulations. So much for no-deal preparations; even legislation protecting vital things like safety has been forgotten.
We have demonstratively seen how poor preparations for no deal are in the Minister’s Department—let us not forget the Operation Stack demonstration, for example. Clearly, his Department is not ready for no deal. Perhaps he can assure the House today, as I have asked his colleagues to do previously, that this is the very last regulation to come on to the Floor of this House to ensure that EU law is enshrined in UK law in the adverse event of the UK leaving the European Union. If it is not, how many more regulations can the House expect?
These regulations deal with the components necessary for the installation of cableways such as ski lifts, the Emirates line and funicular railways, and seek to establish parallel processes to those in the EU, with the Health and Safety Executive and the Health and Safety Executive for Northern Ireland taking over the role of the enforcement body. The United Kingdom Accreditation Service will then ensure that an assessment is made by an approved body—not by the Secretary of State—so that the components for installation meet the required standard. The setting of standards will sit with the Secretary of State, as a new extended power, but he will, in reality, work with industry to set the standards, which will sit under the British Standards Institute.
The CE—Conformité Européenne—certification marker will transfer to the UK, to be replaced by a UK marker. This transfer of functions is a practical solution should we end up with no deal. If we do, it is expected that there will be no divergence from EU standards for the industry—well, at least not to start with. However, it is not clear whether parity with EU standards will be maintained if EU standards advance. Can the Minister confirm this, and set out in what instances he believes   there could be divergence, and how his Government will respond to that? Will he ensure that in that scenario, UK legislation will keep pace with EU legislation? Clearly, for the industry in this specialist field, and the resultant supply chain, it is in the interests of manufacturing and safety standards that there be no divergence, although we can always have better safety regulations, and that we are not forced into a no-deal scenario under the new Prime Minister.
Concern has been raised about fee setting for this process, not least by the Scottish snow sports sector and Transport for London. I note that the Department highlights that that does not come within the scope of the regulations, but will the Minister tell the House how this will operate in a no-deal Brexit scenario, since a transfer of authoritative bodies, inspection bodies and the enforcement body could impact on fees?
Labour will support these regulations this afternoon, but I hope to have some clarity from the Minister on the issues that I have raised.

Alan Brown: Here we go again: the Government have thought it fit to bring this very minor statutory instrument to the main Chamber for debate. Why has a straightforward cut-and-paste job, which simply substitutes references to the EU with references to the UK, merited an allocation of 90 minutes in the main Chamber—or is the Minister trying to big it up? He said that the instrument is about fixing deficiencies and providing clarity and certainty for business, and that the Government developed it in close association with industry and the Health and Safety Executive, but that is not the case; it is a cut-and-paste and substitute job.
There is one slight difference: paragraph 2.8 of the explanatory notes details a “significant change”, in that there is a power for the Secretary of State to designate standards after Brexit day. So there we have it—there is a Brexit dividend: more powers for the Transport Secretary! However, he does not intend to wield these powers, fortunately; there is enough chaos and uncertainty due to Brexit without him intervening and creating further chaos, in line with his legacy.
As the shadow Minister said, we have to ask why, if the Government claimed they were ready for a no-deal Brexit in March, this measure has come forward four months after the original exit day. How on earth can the Government claim that they will pull off a no-deal Brexit deal in October when there is some really heavy legislation that we need to pass through this House in order to achieve that?
Paragraph 2.8 of the explanatory notes also advises that there are no approved bodies in the UK that can carry out conformity assessment, so the EU notified bodies will continue to be recognised. This is actually sensible, but again it shows the absurdity of exiting the EU. Will the Minister advise whether there are any plans to set up a new body?
As has been said, this SI covers 100 cableway installations in operation in the UK, the majority of which are for the ski industry in Scotland. Paragraph 10.3 of the explanatory notes details that, following the consultation, the
“Scottish Snow Sports Sector expressed concern about the fee structure for the inspection of small cableways such as chair lifts.”
Yet a change in fees is not proposed, so can the Minister advise what assessment has been made of the fairness and level of fees, and is there any scope for reductions? Surely if we are to have any Brexit dividend, and the reduction in red tape that we keep hearing about, there must be scope for a reduction in the fees charged to the industry.
It is clear that this SI does absolutely nothing but allow some form of continuity by recognising the EU bodies involved, and changing some references. I will therefore certainly not oppose it, especially as it is particularly relevant to Scotland. I end by repeating my request for the Minister to engage with the ski sector, to see what movement can be made on the inspection fees charged to the industry.

Chris Bryant: It’s a strange old world, isn’t it? This must be the strangest Parliament in many years. We are debating Bills that are no more than clauses, in effect, and we now have on the Floor of the House a measure that would normally have been taken in a Committee Room upstairs. It is actually a measure that the Government—or certainly today’s Government—hope they will never have to implement, because they are hopeful that some kind of deal will be done, so that we are not in the no-deal scenario in which this would be necessary.
There is a fundamental complexity in what the Government are arguing. In the explanatory notes, the Government say that the SI’s whole aim is to mirror precisely what the EU is doing. One therefore presumes, as my hon. Friend the Member for York Central (Rachael Maskell) said, that if there are amendments to EU regulations in this area in the future, the UK Government will immediately implement them in the UK. That hardly feels like seizing back control; if anything, it feels more like ceding control to a body on which we will no longer be sitting. If there are to be European-wide measures on ski lifts—because, I guess, lots of people from across the European Union who travel from one country to another will want to know, when they get on a ski lift, that it is safe—one would have thought the UK would want to take part in establishing those rules and regulations.
The regulation has been admirably and beautifully expounded on by the Minister, who has had more than a wry smile, I would say, on his puckered lips.

Michael Ellis: I always look like this.

Chris Bryant: No, the Minister does not always look quite like that. This proves yet again what many of us have felt for a long time: that Brexit is proving far more complicated than anybody ever thought it would be, and is using an awful lot of our time and energy. Whether it will produce anything more than wind is difficult to know.

Michael Ellis: The hon. Members for Rhondda (Chris Bryant) and for Kilmarnock and Loudoun (Alan Brown) said the SI was allegedly unimportant, but that did not stop them talking to the Chamber about it at some length.
May I say to the hon. Member for York Central (Rachael Maskell) that my Department is actually extremely advanced in the matter of statutory instruments? It has been focusing very strongly on this, and is in a very good place on it. Safety is of paramount importance; these are not minor matters. They are matters of considerable significance, not just for ski lifts but for funicular railways and the other areas we have discussed, including the Emirates line.
We at the Department for Transport have prioritised our SI programme. We have consulted the industry and the devolved Assemblies. We are confident that there will be no impact on safety of not having these regulations in place for exit day, but it is right that we bring them forward now and give the industry clarity, because that is common sense. Standards will not change. Provision will be made for the Secretary of State to set designated standards in future. As ever, that will be subject to full consultation with all the devolved Assemblies.
When it comes to the requirements and duties placed on cableway operators transporting passengers, maintaining the status quo after exit day is perfectly proper and necessary to ensure continuity of operations and safety. The objective of Her Majesty’s Government is to maintain the status quo in order to avoid uncertainty for cableway operators following exit day. I hope Members agree that that is a sensible approach that will benefit communities and the users of these services. I commend this statutory instrument to the House.
Question put and agreed to.

Electoral Commission

[Relevant document: The First Report of the Speaker’s Committee on the Electoral Commission, Re-appointment of an Electoral Commissioner, HC 2513.]

Mel Stride: I beg to move,
That an humble address be presented to Her Majesty, praying that Her Majesty will re-appoint Rob Vincent CBE as an Electoral Commissioner with effect from 1 January 2020 for the period ending 31 December 2023.
The motion proposes that a Humble Address be presented to Her Majesty praying that Her Majesty will reappoint Rob Vincent CBE as an electoral commissioner for a period of four years from 1 January 2020 to 31 December 2023. Mr Vincent has served as an electoral commissioner since 1 January 2016, and his current term expires on 31 December 2019.
It may help if I set out some of the background to this appointment. Electoral commissioners are appointed under the Political Parties, Elections and Referendums Act 2000, as amended by the Political Parties and Elections Act 2009. Under the Act, the Speaker’s Committee on the Electoral Commission has a responsibility to oversee the selection of candidates for appointment to the Electoral Commission, including the reappointment of commissioners. The Speaker’s committee has produced a report, its first report of 2019, in relation to this motion.
The Electoral Commission includes up to six ordinary commissioners, who are subject to restrictions as to political activity. These are recruited by open competition, under a procedure put in place and overseen by the Speaker’s committee. The Electoral Commission also has four nominated commissioners, who are persons put forward by the registered leader of a qualifying party for consideration for appointment. Mr Vincent is an ordinary commissioner and was recruited through an open and fair competition conducted in 2015.
The Speaker’s committee is required by section 3 of the Political Parties, Elections and Referendums Act 2000, as amended, to oversee the procedure for selecting candidates for appointment to the Electoral Commission. Under section 3(5A) of the Act, this duty encompasses the recommendation of candidates for reappointment to the Electoral Commission. There is no presumption in the statute either for or against reappointment.
At its meeting in March 2019, the Speaker’s committee considered a request from Sir John Holmes, the chair of the Electoral Commission, seeking Mr Vincent’s reappointment for a second term. In considering the question, the committee had regard to the report on Mr Vincent’s effectiveness in the role, as submitted by Sir John. In particular, the committee was informed that Mr Vincent’s previous experience as a returning officer in a local authority, and the practical understanding of this work he was able to bring to the work of the commission, had been extremely valuable.
Having carefully considered Sir John’s report, the Speaker’s committee concluded that it was content to recommend Mr Vincent for reappointment. Once the Speaker’s committee has reached a decision, statute requires that the Speaker consult the registered leader of each registered party, provided that that party commands at  least two Members of this House. The Speaker therefore accordingly wrote to the leaders of the qualifying parties in April, consulting them on Mr Vincent’s reappointment. No objections or concerns were received by the Speaker in response to this consultation. The Speaker’s committee therefore commends the reappointment of Mr Vincent to the House. If the appointment is made, Rob Vincent will continue to serve on the Electoral Commission until 31 December 2023. I am sure that, should this motion pass today, his expertise will continue to be appreciated by the commission.

Alan Brown: Given the importance of this reappointment to the Electoral Commission’s work, will the Government start working on the Electoral Commission’s recommendations, including the recommendation that electoral fines are too small and seen as normal, day-to-day business by the major UK parties; and the recommendation about revealing donations in Northern Ireland further back than the cut-off date set by the Government?

Mel Stride: I will say two things in response to the hon. Gentleman’s question. The first is that it is slightly out of the scope of this debate on a motion concerning the reappointment of an electoral commissioner. I will, however, indulge the hon. Gentleman with my second observation, which is that the wider issues that he has raised would be best taken up with the Minister with responsibility for the constitution, my hon. Friend the Member for Torbay (Kevin Foster).

Valerie Vaz: I thank the Leader of the House for moving the motion. I thank the Speaker’s Committee on the Electoral Commission  for overseeing the procedure for selecting candidates for appointment to the Electoral Commission, and for producing its report, “Re-appointment of an Electoral Commissioner”, which was published on 8 July 2019.  I thank Mr Speaker for chairing the committee and I thank the other members: the right hon. Member for Aylesbury (Mr Lidington); the hon. Members for Harwich and North Essex (Sir Bernard Jenkin), for Richmond (Yorks) (Rishi Sunak), for Aberdeen North (Kirsty Blackman) and for Morley and Outwood (Andrea Jenkyns); and my hon. Friends the Members for Ashfield (Gloria De Piero), for Newport East (Jessica Morden) and for Houghton and Sunderland South (Bridget Phillipson).
Rob Vincent CBE has served as an electoral commissioner since 1 January 2016, and his current term of office expires on 31 December 2019. At its meeting on 18 March 2019, the Speaker’s committee considered a letter from the chair of the Electoral Commission, Sir John Holmes, seeking Mr Vincent’s reappointment for a second term. Sir John told the committee that Mr Vincent had consistently achieved the objectives agreed with him since his appointment, and that he had offered valuable contributions to the board’s debates on strategy and resources.
Sir John also noted Mr Vincent’s past experience, which the Leader of the House has outlined, as a returning officer in a local authority, and the practical understanding of that work that he had been able to bring to board meetings. Mr Vincent was chief executive of Kirklees Council between 2004 and 2010, and of Doncaster Council between 2010 and 2011.
After considering Sir John’s letter, the committee recommended that Mr Vincent be reappointed with effect from 1 January 2020 for the period ending 31 December 2023. The Speaker wrote to the leaders of the qualifying parties on 4 April 2019 on the committee’s recommendation. No objections or concerns were received from Her Majesty’s Official Opposition—the Labour party—or, as I understand it, from other parties, so the Opposition support the motion.

Tommy Sheppard: I want briefly, and for the record, to associate myself with the observations made by the Leader of the House and the shadow Leader of the House concerning the suitability of Mr Vincent for his current and future position. The third party has no objection to the motion, and we look forward to Mr Vincent continuing in his role in the Electoral Commission.
Question put and agreed to.

Nationality

[Relevant documents: The Fifth Report of the Joint Committee on Human Rights, Proposal for a draft British Nationality Act 1981 (Remedial) Order 2018, HC 926, and the Twentieth Report of the Joint Committee of Human Rights, Good Character Requirements: Draft British Nationality Act 1981 (Remedial) Order 2019–Second Report, HC 1943.]

Caroline Nokes: I beg to move,
That the draft British Nationality Act 1981 (Remedial) Order 2019, which was laid before this House on 2 May, be approved.
In this day and age, I think we can all agree that the law should not discriminate against people simply because their parents were not married when they were born, and that we should not discriminate against people just because it was their mother who was British, not their father. The draft British Nationality Act 1981 (Remedial) Order 2019 is designed to remove discriminatory provisions in the British Nationality Act 1981 for those applying for British citizenship under specific routes introduced to address historical discrimination against those whose parents were not married, or against those whose mother was British, as opposed to their father. The draft order was first laid in Parliament in March 2018.
Once the law has been changed, those who seek to register as British citizens and who were born to an unmarried British father before July 2006, or to a British mother before 1983, will no longer need to demonstrate that they are of good character where it would be discriminatory to require them to do so. In two separate cases, the courts declared the good character requirement to be unlawful and made a declaration of incompatibility with the European convention on human rights. This legislation will correct incompatibilities identified by the domestic courts by removing the good character requirement for those applying for British citizenship via certain routes on the basis of historical discrimination. I am grateful to the Joint Committee on Human Rights for its scrutiny of the order and its careful consideration of this hugely complex and sensitive issue.
The remedial order process to correct incompatibilities in primary legislation with the European convention on human rights is rarely used. It is therefore right that each order is scrutinised carefully to ensure compliance with the procedure laid down in the Human Rights Act 1998, and to ensure that the incompatibilities found by the courts are addressed.
The Government welcome the Committee’s recommendation that Parliament approve the order. It remains our position that some of the issues raised by the Committee go beyond the incompatibility rulings and are therefore outwith the scope of the order. I commend this order to the House.

Afzal Khan: The good character requirement has wrongly blocked children from registering for their right to British citizenship. We support the statutory instrument because it corrects a discriminatory and wrongful requirement. This requirement in relation to citizenship is highly controversial and, simply put, it is outdated in the present climate. British nationality law granted automatic citizenship by descent only to children born in wedlock to British fathers.  Although previous changes have allowed children born to British mothers or fathers to become British citizens by descent whether their parents were married or not, discrimination remained because they were required to prove good character.
Concerns raised by the Joint Committee on Human Rights, the courts, numerous organisations and young people themselves all indicate that it is inappropriate to apply the good character test to children who have a right to be British. The statutory changes proposed today would address those concerns by removing the requirement to prove good character. It is disappointing that the Home Office had to be taken to court to be forced to make this change. I hope the Home Office will not wait for another court ruling to address the other glaring problems with UK nationality law, especially in relation to children.
We believe that the good character requirement has led to serious discrimination. Children from BME backgrounds, as well as children in care, are much more likely to be denied citizenship because of unequal treatment in the criminal justice system. The root of the problem came about when the Government began blurring the distinction between registration and naturalisation. The original good character requirement was not defined, and it related to adult migrants applying to naturalise as British citizens. Since then, the requirement has been applied to children who were born and grew up in the country of which they wish to register citizenship, thereby wrongly denying them their rights to register British citizenship.

Jim Cunningham: I strongly agree with my hon. Friend, who has raised an important point about discrimination. Lots of children came to this country, possibly as refugees, and are in care. When they reach a certain age, they have difficulty getting British citizenship. Surely, that has to be put right.

Afzal Khan: I agree with my hon. Friend. Denying someone their right to citizenship of the only country they have ever known is a heinous overreaction to a policy caution, especially for children as young as 10.
Concerns remain about citizenship, most prominently in relation to cost and access to legal aid. The JCHR recommended that the Home Office should not charge an application fee to those who have previously been discriminated against. Can the Minister confirm that that is the Government’s intention? When we can expect that to be made clear in legislation? The Government are making a profit on fees charged to children who are registering their right to British citizenship, and those who cannot afford the fee will effectively be denied their right to citizenship. We believe that that is wrong. Will the Minister set the fee for citizenship at cost price, and will she make sure that full fee waivers are available to any child who cannot afford the fee?
As we approach the deadline for EU settled status, there will be a number of children in local authority care who will need to be registered. That brings into sharp relief how little we know about the immigration status of children in care of the state. Many children will be entitled to citizenship, but not aware of it. What steps is the Minister taking to work with local authorities to identify those children with insecure immigration status, and ensure they receive proper legal advice?

Stuart McDonald: First, I apologise to you, Madam Deputy Speaker, and to the Minister and colleagues for my late arrival in the Chamber. I have learnt a lesson on not overestimating how long previous debates will take. My apologies to everybody.
The order is not controversial. I am grateful to the Joint Committee on Human Rights for all its work  on the draft order and the order proposed today. It recommended that the order be passed, and I fully agree. It seeks to put right discriminations that still exist in nationality law and that is something we all support. I will make a couple of brief points on that. The Joint Committee report, in chapter four, points out that as it stands the order will not fix the apparent discriminations highlighted in the Committee’s first report, and leaves the Home Office open to potential legal challenge. Specifically, it raises that issue in relation to children who were discriminated against solely because their parents were not married and adults who were discriminated against when they were children. The Home Office will have to look at that again.
The Committee flagged up, in chapter six of the report, that the very same discriminations are still being faced by British overseas territories citizens. If they face the same discriminations, why are they not being provided with the same remedies? It is time for the Home Office to look at that issue again, too.
The Joint Committee also raised two more general points. First, there is a serious question about whether it is even remotely appropriate to ever apply good character tests in many of these situations at all, especially in relation to children. Personally, I find the whole notion of testing good character in children troubling and pretty awful. Attempting to wash our hands of “problem kids” via nationality law is disturbing. It seems to me that the Home Office has lost its grasp of, and become confused by, the different types of nationality applications. I think few Members would argue that having such a test apply in naturalisation applications, for example, is perfectly reasonable. Nobody would quibble with that, but since changes were introduced in 2006 and 2009 successive Governments have presided over the application of a good character test way beyond its appropriate use. In particular, it has even been applied to kids over 10 who otherwise have an entitlement to British citizenship.
Finally, I agree wholeheartedly with what the shadow Minister said about fees. In 1981, when there was a radical reform of British nationality law, this place was extremely protective of the rights of kids who, although not born here, had an entitlement to become British citizens afterwards. They have been denied that entitlement because of exorbitant fees for applications. We need radical reform on that by the Home Office.

Caroline Nokes: I am grateful for the considered debate today and the interest that Opposition Members have shown in this remedial order.
As I said earlier, the scope of the remedial order  is to make changes to nationality legislation and it is therefore narrow. It is limited to addressing the specific incompatibilities that have been identified by the courts.  The Government will monitor any remaining potentially unlawful discriminatory aspects of nationality legislation, a point picked up on by the hon. Member for Manchester, Gorton (Afzal Khan), and will consult as appropriate if it becomes apparent that further changes are necessary.
The Government are committed to ensuring that those individuals affected by the order do not face further discrimination. In its first report on the remedial order, the Joint Committee on Human Rights recommended that those who had citizenship applications previously refused, because of the discriminatory provisions in the British Nationality Act 1981, which this order seeks to remedy, should not have to pay the application fee for a repeat application. I am pleased to say that I have written to the right hon. and learned Member for Camberwell and Peckham (Ms Harman), the Chair of the Committee, confirming that I plan to amend the fees regulation at the next opportunity to waive the application fee for this particular cohort.
Turning to the points raised by the hon. Member for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald), he commented on children having to meet the good character test. This is a requirement for British citizenship as set out in the 1981 Act. It applies to those seeking to register as British who are aged 10 years and over at the time of application. That is because 10 is the age of criminal responsibility in England and Wales. Children as young as 10 can and do commit very serious acts of criminality, sad though that is and undoubtedly tragic for their victims. It cannot be right that such offences are disregarded when assessing a child’s suitability for citizenship.

Stuart McDonald: I do not agree with the Minister on that point of principle, but even putting that to one side 50% of kids over 10 who are denied citizenship on   those grounds have had that done on the basis of nothing more than a police caution, as I understand it. Surely it cannot be right to deny someone the right to citizenship on such a flimsy basis?

Caroline Nokes: I was just moving on to that particular point. The Government do not believe that the good character requirement for children is at odds with the statutory obligation in section 55 of the Borders, Citizenship and Immigration Act 2009, but I want to make very clear that having a criminal conviction does not necessarily mean an application for citizenship is automatically refused, particularly in the case of minor offences attracting an out-of-court disposal, for example, as the hon. Gentleman mentioned, a youth caution. Each case is considered on its individual merits and guidance for caseworkers makes it clear where discretion can be exercised.
On British overseas territories, we are very proud of our heritage in Britain and this pride extends to many people around the world who identify as British. The JCHR expressed concerns that the discriminatory provisions that this remedial order seeks to remedy will still apply to British overseas territories citizens. Regrettably, this is true. When changes to nationality legislation were made, they were introduced at a very late stage in the parliamentary process and there was no time to consult fully with the territories about introducing similar provisions for British overseas territories citizens’ status. It would not have been right to introduce legislation that would affect the territories, and potentially the status of those living there, without consultation. We recognise the difficulties that the British Nationality Act still presents for some British overseas territories citizens, who may wish to pass on their citizenship to their children and are considering how best to address those concerns, taking into account the opportunities for doing so. I commend the order to the House.
Question put and agreed to.

Body Image and Mental Health

Jackie Doyle-Price: I beg to move,
That this House has considered body image and mental health.
I am delighted to open this debate on this very important matter about which a number of parliamentary colleagues are showing increasing concern. How we think and feel about our bodies can affect any one of us at any point in our lives. I am sure I am not alone in not liking my body shape and in wanting to lose more weight. Frankly, we know there is no magic route to that. We just need to eat less and drink more—[Laughter.] I should say: eat less, drink less and exercise more. Too often, however, people are seduced into seeking body shapes that are less than attainable. While for most of us that is an aspiration, for some people it becomes uncomfortable and an obsession that does them no good.
This is a particular issue today, because the pressure on people, especially young people, to achieve an idealised image is everywhere. Often, the images that people are being subjected to are unattainable because those images have been airbrushed and touched up. Those shapes are really not what any normal person could begin to achieve.

Jim Cunningham: The Minister is quite right. Some of the television reality shows today put pressure on young people, particularly young girls, to imitate shapes, weight and size, and all that goes with that. This is a timely debate and we need to have a good look at this issue. At the end of the day, young people get very disappointed and that can have an effect on their mental health. That is the important point we should not lose track of.

Jackie Doyle-Price: The hon. Gentleman raises an issue close to my heart. When we talk about so-called reality TV programmes, it is as if the people participating in them are normal people. The reality, however, is that they are not normal people. They are semi-professional celebrities who have often undergone enhancements to become attractive to be chosen to go on these television programmes. The whole thing starts to develop insidiously in a culture, making people think that they should aspire to look like that and that it is normal. Everyone is chasing a lifestyle that is frankly not attainable.
We have all enjoyed watching such programmes. I often say that we have become a nation of voyeurs, but perhaps we all need to remind society that there is no quick route to fame, fortune and success—that comes as a result of hard work—and that spending a bit of money on a nip and tuck and a lip filler will not be the route to earning a lot of money. We all need to start to address that, because we have allowed magazines and our media to develop this image. We have been complicit in it happening, because we have enjoyed that entertainment, but we are reaching a position where our society is extremely unhealthy.
The problem has been made particularly acute by the growth of social and digital media, which have increased exposure to unrealistic and unattainable images of beauty. As we all know, when we are browsing on our iPad we  can look at one thing and straight away be bombarded with sites that squirrel us down a route where we are exposed to more and more such content. People who are looking at unrealistic body images will see ever more images that they aspire to. There is another insidious thing: a friend of mine was speaking to me only last night and said that she was looking at cosmetic procedures when, all of a sudden, an advert popped on to her screen encouraging her to spend a few thousand pounds so that she could learn to administer lip fillers herself. She thought how horrendous it is that our social media does that.

Mary Glindon: Is the Minister aware of the Be Real campaign’s latest report, “The Curate Escape”, which looks at young people and their images on social media? Two thirds of young people edit pictures of themselves before they put them on social media, and the report makes a lot of really good recommendations. The Be Real campaign has been fantastic in recent years, focusing on health and wellbeing, rather than weight and people watching their weight. If she is not aware of the report, would she like a copy?

Jackie Doyle-Price: I thank the hon. Lady for raising that point—I have heard of that campaign. It is disturbing that so many people alter their images. None of us is perfect—God help us if we all were—but for people to think that they need to alter their appearance because they are unhappy with it, and for that to become normalised, is quite a sinister development in society. At the risk of being trite, perhaps we should be telling everyone to learn to love themselves.

Bambos Charalambous: Is the Minister aware of the Good Childhood report, which states that girls who share pictures or videos of themselves are less happy with their appearance than those who do not? Is she aware that the Children’s Society are campaigning for a greater understanding of what makes children unhappy, and does she agree that we need to focus on that?

Jackie Doyle-Price: Yes. The Children’s Society is doing some excellent work in this space and it always has a lot of expertise to share. We have to address this issue collectively as a society, because if we do not start equipping children with the tools to look after themselves and the right attitudes, that damage is set up for life. The hon. Gentleman is absolutely right to raise that point and I encourage the Children’s Society to engage with us more on what we can do to support it.
The Government recognise that poor body image is a common problem. Approximately 70% of adolescent girls and 45% of adolescent boys want to change their body weight or shape. We also recognise the impact that idealised body image can have on lesbian, gay, bisexual, and transgender people particularly, on ethnic minorities, and on those with disabilities or serious illnesses.
The Mental Health Foundation recently published a very informative report on body image. Some of its findings are shocking: 20% of adults feel shame, 19% feel disgusted, and 37% of teenagers feel shame in relation to their body image. This should make us all stop and think. When it comes to teenagers, we all recognise that going through adolescence is a difficult time, when we  are at our most vulnerable, including to the outside influences that tell us that our body shape is not as it should be and that we are not as perfect as we could be. I welcome the recommendations made in the foundation’s report, which is aimed at public and commercial organisations and gives us things that we can do to help ourselves.
Having a negative body image affects the way that we feel about ourselves and it can affect people’s aspirations and confidence. In the most extreme cases, it can lead to eating disorders, depression and even feeling suicidal. I know that the hon. Member for Dewsbury (Paula Sherriff) is as concerned as I am about this issue, and I commend the work that she has been doing specifically on eating disorders. The increases that we are seeing in suicide and self-harm among young people are incredibly worrying. Much of this is being driven by young women and girls, but we must not forget the boys either. It is important that we work to raise awareness of the problems of body image that many people face and hopefully prevent them from developing issues in future.
Clearly, social and digital media companies are key players in this debate, because they contribute to the volume of material that encourages people to think negatively about themselves. Young people are put under such pressure to have the perfect image, the perfect body, the perfect relationship and the perfect clothes—the perfect everything—and that places unrealistic expectations on them. As hon. Members will know, we are in close dialogue with social media companies to encourage them to act more responsibly over the content on their platforms. We have held three summits so far; the most recent was only last week. We have said that, ultimately, we will consider legislation if they do not clean up their act. That said, Governments can always be three steps behind the development of technology, so I would much rather that we worked collaboratively and co-operatively to address this content.
So far, I have been encouraged that the companies have committed to increasing their efforts to protect users from harmful suicidal and self-harm content online by coming together to establish and fund a strategic partnership with the Samaritans. That work is commencing. They will look not only at self-harm and suicide, but at pro-eating disorder content. We will continue our meetings with social media companies.
I was particularly concerned to see that a number of sites and materials are available that contain harmful content such as pro-anorexia messages. It is completely unacceptable that this sort of content is easily accessible to vulnerable young people. We are having talks with Amazon about removing books from its retail sites, but we need to ensure that social media companies are vigilant about taking down content published on their sites as well.
In the face of these modern challenges, central to tackling the problems in future is empowering our young people to improve their emotional resilience and wellbeing, so that they feel confident in themselves and in seeking support if they feel they need it. We are investing in massive improvements in mental health provision in schools. We have a new workforce that we are rolling out. We also need to make sure that children can access mental health support and we are investing  in more provision in child and adolescent mental health services. As part of making health education compulsory in schools from September next year, it will be absolutely essential that we teach children how to protect their mental wellbeing. That will cover unrealistic expectations about body image. I hope that that will allow young people to recognise what is normal—what is normal, and is there any such thing as normal?—and what is an issue for them and others, as well as to know how to seek the right support when issues arise and to know that it is accessible to them.
Another issue I would like to talk about is gender identity, which has been the subject of quite a number of negative reports in our newspapers in recent months and, indeed, on Radio 4 this week. This is about people’s sense of self and physical appearance and about them wanting to change their gender identity. We have been aware of the issue of gender dysphoria, but there has been quite a lot of comment, and the House and the public need reassurance that the treatments available on the NHS, particularly for children, are appropriate.
To put the issue in context, gender dysphoria is where a person experiences discomfort or distress because there is a mismatch between their biological sex and their gender identity. That is incredibly difficult for anyone to deal with, but young people, in particular, will find it difficult. Many Members will have had representations from constituents about access to services to cope with gender dysphoria—I know that because I have signed many letters on the issue. It is essential that someone suffering with gender dysphoria receives the right support—support that really considers their holistic needs—because gender dysphoria often exists alongside other morbidities, and we must make sure we treat the whole person. Where appropriate, people should receive specialist treatment.
The Gender Identity Development Service for children and young people is provided by the Tavistock and Portman NHS Foundation Trust. There has been lots of concern in the press about that trust, but having discussed the service with NHS England and visited it, I would like to try to give Members some reassurance and to address some of the points that have been made about the service.
The first thing I think the service would like to get across is that gender should be seen as a spectrum. The whole treatment pathway is based on allowing children to explore their feelings in a safe environment. Not all children referred to the service will go on to transition. That is an important point to recognise, because if children have the time and space to work through their feelings, that will perhaps lead to a different treatment pathway.
I know there has been lots of concern that too many children are being referred to the service, but I would like to reassure the House that the service takes children through treatment in a very exploratory way around gender, and more than half of the children referred do not go on to transition. The service will treat each case as individual and complex and will address some of the co-morbidities that come along with gender dysphoria—lots of concern has been raised about the fact that some of these children are also on the autism spectrum.
It is important to recognise that, compared with services internationally, the service is very much at the conservative end of provision, which has led to it being  criticised as far too conservative by some aspects of the lobby in favour of more services. However, where we are dealing with children who have not reached the age of majority, and where some of the treatments they may go through may be irreversible, the whole issue of consent is clearly important.
It is important to note that this aspect of service has grown quickly, and it has done so in an absence of public scrutiny. I can understand why there will be some public concern about it, so I would like to reassure the House that I am working with NHS England to do a proper review of the research around this service and the ethics of it to establish a proper framework for consent, recognising that we are looking at treatments that may have long-term consequences.
I can assure the House that the service works hard to ensure that consent is robust and that young people who might receive hormone therapy receive adequate information about the nature and consequences of that treatment. Such consent is not a one-off decision; it requires ongoing dialogue with the service. It will also require some assessment of the capacity and competence of the individuals consenting.
It is important to assure the House that this issue is very much under review. My starting point is that nothing should be undertaken in this space that would be irreversible for anyone under the age of 18. With that in mind, NHS England is putting in place a new policy and a new service specification for children’s services, and will thoroughly consider the issues that have come up in the press recently. Clearly, those issues will be a matter for debate, and many Members will have an interest in them. It is important for public confidence, as well as to enable access to services, that we have a proper, ethical debate around consent and the clinical evidence behind prescribing long-term hormone treatments.
Finally, I want to say a little about cosmetic procedures and regulation. I am pleased to see the right hon. Member for North Durham in his place—he is my conscience on these issues. It is fair to say that they are becoming increasingly common, and as they do so, they are becoming increasingly risky. Increasingly, it is becoming normalised for young women, in particular, but not just young women, to seek cosmetic procedures to alter their appearance.
I was pleased to launch an awareness campaign around cosmetic procedures earlier this year, which I have driven forward to make sure not only that we encourage people to properly consider the risks of any procedure they might undertake, but that they do not just wander down to the hairdressers and book a Botox appointment or a filler but really take steps to make sure they are going to a reputable provider. It is important that people fully understand the risks and where to look for a safe procedure. We have made sure that there is good material on the NHS website, and we are encouraging people to access that information when they are considering having any kind of procedure.
However, there is a really important message that we must give, which is that anyone considering having anything done to their appearance should not seek an operation overseas. There are some very disreputable operators advertising—for example, there are holidays in Turkey with a procedure. That is hugely dangerous,  and I am afraid that the NHS is picking up the costs of those procedures. That is obviously something we need to address properly.
We will look at stronger regulation of the sector. Again, I would say that no one under the age of 18 should seek a cosmetic procedure. We have come to think that having some kind of lip filler is just like going to have a haircut, but when it goes wrong the results are much worse than having to let our hair grow back. Therefore, no one under the age of 18 should be seeking such procedures, and we need to do a lot more to make people realise exactly what the risks are.

Bambos Charalambous: Obviously, the harm is  done with young people early on, and they are very impressionable—we have mentioned reality TV, and the Digital, Culture, Media and Sport Committee is looking at its impact. Does the Minister not think that we should try to teach positive body image at school and provide support at school for people who have concerns about their body image? That would be a wise investment of Government funds and would actually help young people to address their concerns and anxieties at every stage.

Jackie Doyle-Price: I agree with that. Through the new personal education that will be rolled out next year, we will have the ability to address that issue. I would just say that we need to be careful about this and to give some scrutiny to what the content of that might be. We have to really make sure that people respect the fact that we are all different and we all come in odd shapes and sizes, but everyone is beautiful. That is a really important message to convey. It will be incredibly challenging to get that content right, and we do need to bring some scrutiny to that.
Body image is clearly a strong contributory factor in many cases of mental ill health. I am pleased that we are starting to tackle some of these issues, but there is a long way to go. We have reached a stage at which the herd has gone so far down the road that the idealised view that everyone is a size zero model whose perfectly coiffed, long, naturally blonde or brunette hair has no shades of grey and no curls has taken hold. It will take a long time to turn that juggernaut around, but in the interests of a healthy society we all need to get a grip.

Paula Sherriff: Let me start by welcoming the Minister to the Front Bench. I am glad that she is still in her post, and I sincerely hope that this is not her last appearance at the Dispatch Box in her current role. She has been collegiate, engaging and very co-operative, and I thank her for her kind words about eating disorders. I agree with most of what she has said this afternoon.
“Body image” is the term that is used to describe the way we think and feel about our bodies, which can have an impact on us throughout our lives and cause poor mental health and a lack of wellbeing. While the association between body image concerns and poor mental health is definitely not new—we have been discussing it for decades, and I am sure that we will still be discussing it for decades to come—I think it is fair to say that the problem is worse now than it was just 10 years ago. There is a far greater exposure to the media and to  social media, and there is also our need to have everything, right here and right now, in the impatient and judgmental world in which we live. As the Minister said a few moments ago, we still have a long way to go in tackling this issue. Would it not be great if we recognised that, literally, one size does not fit all?
Body image concerns are extremely common, and vary in severity. Not all body image issues will affect mental health. However, it is important to be aware of the risk factor, especially among young people, as the risk of developing an eating disorder is closely associated with poor body image. The Mental Health Foundation has undertaken a great deal of research in this area, and recently conducted a survey of 4,505 UK adults aged 18 and above and 1,118 UK teenagers aged between 13 and 19. The results showed that one in five adults felt shame about their body image, 34% felt down or low, and 19% said that they had felt disgusted because of their body image in the last year, with 13% saying, very worryingly, that they had experienced suicidal thoughts and feelings. The survey of teenagers revealed that  37% felt upset and 31% felt ashamed in relation to their body image.
Perhaps more worrying are the results from Be Real’s Somebody Like Me campaign. The researchers spoke to more than 2,000 secondary school pupils aged 11 to 16 from across the UK, and found that 52% regularly worried about how they looked, 30% isolated themselves because of body image anxiety, and 36% said that they would do “whatever it takes” to look good, including considering cosmetic surgery. Similarly, 10% of boys surveyed by the Mental Health Foundation said that they would consider taking steroids to achieve their goals.
As the Minister said earlier, we must recognise that body image challenges affect boys as well as girls, and men as well as women. Unfortunately, my hon. Friend the Member for Islwyn (Chris Evans) is not present, but he has previously spoken powerfully about the body image challenges that he faced as a younger man, and I think that he is a great ambassador for this issue.
It is a shame that more Members on both sides of the House are not present for such an important debate. I understand the significance of today and the fact that other things are obviously going on, but for the benefit of those who are watching in the Public Gallery and others who may be watching at home, I want to reiterate my support, and that of the Minister and other Members in relation to this issue.
The shocking statistics that I have cited highlight the need for more support and help. Perhaps most worrying is the finding that a desire for the option of cosmetic surgery appears to be more and more widespread. I welcome what the Minister said about the need for stronger regulation, because cosmetic surgery has almost become normalised. Many of my friends have lip fillers and Botox treatments. I have not succumbed to either as yet, but people are now moving away from breast augmentation and talking of “bum lifts” and “Brazilian bums”.
A young and beautiful lady from a constituency not a million miles from mine, in Leeds, went to Turkey—last year, I believe—to undergo one of those procedures, which involves the injection of fat into the bum. I am  not sure whether that is parliamentary language, Madam Deputy Speaker. She was a mum of three beautiful boys, and she never came home. She died during the procedure. I understand that inquiries may well be pending in that case, but it is very worrying that people are going overseas to seek cheaper treatments when there may be issues relating to, for instance, regulation.
Given mainstream television programmes such as “Love Island”, which shows girls as young as 21 who have already undergone plastic and cosmetic surgery, it is hardly surprising that those who watch such programmes aspire to the same treatments. The same applies to tanning salons. In those reality programmes, everyone is bronzed and slim, and the people watching think. “I want to go to one of those.” It is very worrying, partly because some of the less scrupulous tanning salons do not necessarily follow the regulations that are so important to avoiding skin cancer.
It has been widely accepted in many different body image studies that those who are most at risk of developing mental health problems associated with poor body image are women and members of the LGBT community, but, as has already been pointed out today, that does not mean that we should dismiss the incidence of such problems among other groups, although they are not as prevalent. There is no group of people who have not been identified as having certain risk factors or anxieties associated with how they view their body image.
Airbrushed photos have appeared for decades in the media, from the early glossy magazines such as “Just 17” in the 1980s to the internet today. Throughout the internet, images are portrayed that invade people’s lives daily. Indeed, when undertaking research on this subject, I found that the search results on the internet were not giving information about the history of airbrushing, but were offering tips and trying to sell software enabling people to airbrush their own photographs. It should come as no surprise that the increased number of airbrushed images across the internet that are accessible to millions of young people have played a part in the huge increase in the number of people suffering from body-image anxieties in recent years.
During the Minister’s speech, my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and I were looking at an internet picture of Serena Williams, the famous and phenomenal tennis player. She recently appeared on the front page of “Harper’s Bazaar”, and had specified that she did not want the images to be airbrushed. I should add that those images were themselves phenomenal. It was a great lesson, and I hope that other celebrities will consider doing the same. Some have had their pictures taken make-up free, which is also a great thing to do.
We have also seen an increase in the number of television programmes that heavily promote the idea of a “perfect body type”. As I said earlier, “Love Island” is probably the most topical and talked-about programme of the moment. It focuses primarily on young men and women, all of whom can only be described as nothing less than beautiful. Even the show’s host allegedly admitted in 2017 that it portrayed unrealistic body image standards, and, at the start of the current season, Twitter was alight with comments from viewers about how inadequate the contestants were making them feel. I understand that a “plus size” person has featured in the programme this year. I have to say that I have never watched it—my  research evidence comes from the internet, and from friends and, dare I say, staff members who do watch it—but I understand that the producers’ concept of “plus size” may not be the same as ours.
I love to read glossy magazines—many of us do when we get the time—and sometimes looking at the models I do think, as somebody who would love to lose a bit of weight, “Crikey, could they even put in someone who is average-sized?” The average UK female dress size is 16, and some of these models, frankly, look unhealthy.
I want to share a story. I went to a big department store in London just before Christmas last year, and I asked for a dress that was out on the rail in a concession in the store. The size I wanted was not available and the lady working there said to me, “Oh, I’ll have a look in the back for you, as that doesn’t mean we haven’t got it; we just only display sizes eight, 10 and 12.” There is so much that we can do working with the corporate world as well to change these attitudes, and it is very important. We cannot overestimate the impact of little things like not displaying bigger sizes because the designers do not want that look.
“Love Island” is far from the only culprit in the world of television. In recent years there have been many programmes, including “The Only Way is Essex”, “Geordie Shore” and “Made in Chelsea”, that seem to focus on what for many is an unattainable body type. It is almost an oxymoron to call them reality shows when in actual fact they do not portray the reality of the way the average person looks.
The TV programme “Loose Women” has to be applauded for its body confidence campaign last year. It is easy to think that people in later life do not suffer from body image anxieties, but a Mental Health Foundation study found the contrary: approximately 20% of adults aged 55 or over admitted to feeling anxious or depressed specifically because of their body image. Campaigns such as this are incredibly important by helping to show people that their anxieties are shared by many. Indeed, a friend of mine will often say that everyone is too busy worrying about how they look themselves to ever notice how someone else looks, and I do wonder how much truth there is in that.
Sadly, however, that does not appear to be true of how people in the public eye are judged. Body-shaming and trolling of celebrities are prevalent in the media and are on the increase. when Gemma Collins took to our screens last year as a contestant in “Dancing on Ice” she received the most appalling treatment from not only the public but also, disappointingly, one of the judges, most of it based solely on how she looked.
Sadly, it almost appears to be acceptable in today’s times for those we unaffectionately term “keyboard warriors” to hound and troll people who are well known. As politicians, we all, sadly, suffer abuse on social media too, and I am certainly not immune from that. Reference is often made to the fact that I am overweight, by saying, for instance, “You fat cow.” That is absolutely unacceptable, as it also would be if the trolls were referring to somebody as too thin. It saddens me greatly to see that.
All too often the social media companies are turning a blind eye and refusing to take action over comments that are ruining lives. I am sure we will all at some point have received a message after reporting a post on social  media saying, “It does not contravene our rules and regulations.” Indeed, I reported something to Facebook a couple of weeks ago and the reply was, “It does not contravene our community standards,” which raises the question of what on earth its community standards are. The term “standards” here is an oxymoron, perhaps. I have often wondered how far someone would have to go before these companies took any action. A Mental Health Foundation study found that 22% of adults and 40% of teenagers said that images on social media cause them to worry about their body image. Personally, I would like to see much more regulation around social media and much more robust complaint mechanisms that make reporting easier, with more complaints upheld and firm action taken.
It is no coincidence that an increase in social media use is accompanied by an increase in body image issues, which in turn is accompanied by low self-esteem and poor mental health. While I appreciate that social  media also has many positive aspects, we must ensure that these are not outweighed by the negatives. As parliamentarians, we all have a duty to do whatever we can to hold social media companies, TV producers, advertisers, magazines and individuals to account where they are seen to be promoting negative or unachievable body images. We also have a duty to ensure that the correct help is available so that everyone, specifically our young people, are able to use vital services and support to help combat the growing link between body image and poor mental health.

Lisa Cameron: It is a privilege to speak in this debate. Indeed, it is always a privilege to speak in debates about mental health, and, having worked as a psychologist prior to coming into Parliament, I always think my timing has been good, because 10 or 15 years ago we would not have been speaking about mental health, and the doors to any conversation about it would have been firmly closed.
I am always grateful that these issues are prioritised by Government. The Minister has been doing a fantastic job in this regard, working cross-party, and she has all our support. I thank her for the work that she has done and I too hope she continues in her place; if I could send in a recommendation or something, I would be very happy to do so.

Andrew Griffiths: I am not sure a recommendation from the Opposition Benches will help.

Lisa Cameron: Indeed.
Body image is a very important issue, and it is an interesting one as well, because it is coming more to the fore through social media and through society in current times, when there is this striving for perfection. As we heard, in the past that might have been about looking through glossy magazines , but now it is all about how glamourous we can look on Facebook or Twitter, how many friends we have, and how many people want to befriend us because of the way we look—because they think that equates with our being some kind of fantastic person, when of course it often does not. And sometimes the most glamorous of people can also be the most shallow, I have to say.
Society is encouraging stereotypes that place great stresses on our young people today, and that has an adverse impact on their mental health. Social media companies must look at this in much more detail in terms of regulation, as we have heard. I have been very pleased to contribute to the work done through the Department, which is looking at issues of social media abuse and the impact of social media on young people’s development and mental health and how they relate to the world. It is almost as if we have become an artificial world rather than engaging with each other in our day-to-day lives just as we are, with all our diverse shapes and sizes being the norm.

Andrew Griffiths: The hon. Lady is raising some very important points, and I think we all recognise that young people are under more stress and pressure than ever before, particularly through social media. Does she agree that schools have a key role to play in trying to provide support for young people? I am sure that, like me, she welcomes the new Trailblazer programme that the Government have offered, but does she agree that if we can ensure that young people feel able to ask for support and help in the classroom—in the school environment—we will have a better opportunity to tackle these issues at the very start and help those young people before the problem gets worse?

Lisa Cameron: Yes, those points are well made. We must do much more in the classroom to help young people grapple with social media issues and pressures, and to develop positive mental health and coping strategies so they can do that. We also have to help parents, like me and others here today, to understand social media; often children are far ahead of us and it can be very difficult for us to regulate what is happening online and make sure it is safe and secure.
I also commend the work of the all-party group on mentoring and the Diana Award. I recently went to a number of their events, one up in Scotland at Holyrood and one at Westminster just a few weeks ago. They are doing fantastic work to help young people who are being bullied in school and to provide peer mentors, because often, as we know, young people listen to other young people rather than parents or teachers. The work they are doing is going a long way in giving young people skills to understand how to challenge bullying, and to promote good mental health and to understand that it is very important that we support each other in society, rather than doing each other down. I commend them for their work.
I am chair of the all-party parliamentary group for textiles and fashion, which is undertaking an inquiry into inclusion in the industry. We have started our inquiry sessions, which have been extremely interesting. We have heard that although the industry is trying to become more diverse and to promote more diversity among its models and the work that it prints, there are still many challenges and barriers for young disabled people and plus-size people in becoming models or getting into the industry at any level. We hope that the inquiry will highlight and raise awareness of the  issues and ensure that the industry lives up to our expectations that it should be inclusive and diverse, just as the United Kingdom is.
The all-party parliamentary group on psychology recently conducted a research study that showed that although the number of abusive posts to politicians was almost equal across the genders, the content was quite different. Whereas male politicians were criticised for their position on a policy, female politicians were much more often criticised for the way they looked, held to account for not wearing the right things in Parliament—according to whoever they thought was the fashion guru—or trying to do them down based on their personality or personal appearance. That shows the stereotypes that must be overcome and the challenges in feeling confident in politics. We must support everyone to make sure we have a diverse Parliament moving forward.
When I highlighted this debate online today, my constituents asked me not to forget to mention how men are affected in terms of body image. That is such a good point. We often speak about the impact on women, and I have been doing that in much of my speech. They said, “Please don’t fail to mention how men are impacted because this is increasingly an issue in society, and the same stereotypes apply: having to be really buff, no matter what your day entails or if you are running about trying to juggle lots of different things. Always having time to go to the gym and to look fabulous and have all the best clothes etc—these things also put pressure on young men.” I attended a very sad but poignant tribute at the weekend to my constituent Ryan Coleman, who sadly took his own life. We really cannot underestimate the pressures on young men’s mental health nowadays in society. It is incumbent on Governments across the United Kingdom to ensure that young men as well as young women feel able to come forward, be referred and take up services; there is often much more stigma for young men in accessing services and acknowledging some of these issues.
We have spoken about cosmetic procedures. I do not have too much detail to speak about on that, but I am aware that there is not much regulation of such procedures and it is important that we get on top of that. As the Minister and the shadow Minister mentioned, when things go wrong, it is not just like having to go back to the hairdressers and getting a different colour put on. Cosmetic procedures can have a permanent impact on people, or affect them for a very long time, so regulation in this market is important. Other markets may be diminishing, but this market is growing exponentially so we definitely need to have regulation in place.
When I worked with people who have eating disorders, we knew from the research that body image was a core part of the issue that people struggled with. It is not just about weight; it is about cognition. It is about how people think about themselves. I worked with young people who were growing thinner by the day and had anorexia nervosa but felt that they were fat. When they looked at themselves in the mirror, they saw themselves as overweight and strove to lose more and more weight. When an eating disorder develops over time, we know that cognition becomes affected. That is why it is very important that people can be referred to local services. I know how difficult that can be.
When I was doing some work in mental health primary care, the problems in referring someone to tertiary care and eating disorder services were almost insurmountable. People had to go through the community mental health   team. Weight comes into it again. They might not be quite at the threshold, but everyone in the family and the clinicians knows that the person is developing an eating disorder. We must have services that accept people, and a clear clinical pathway. Otherwise, by the time people arrive at the service that they need, their condition has deteriorated so much that they may need to be admitted to hospital.
We also need to ensure that we can treat people with eating disorders as close to home as possible. They often need cognitive behaviour therapy or family therapy, and families really need to be involved in that care. If the care is taking place 20 or 30 miles away from where the person lives, it is so difficult for families who are grappling with all the other demands on their time to be as involved as they really want to be.
Ahead of Mental Health Awareness Week this year, the Scottish Government announced a new advisory group on body image and young people’s mental health. It is important to have that group up and working; to be thinking about the issues that test young people today. We need to be ahead of the curve. The Scottish Government also recently announced a package of funds for social media advice for young people. We are very aware of the impact of social media. When we are looking through magazines, we can put them down and go off and do something else, but social media is constant. I see this with young people, including my own children: as soon as their phone rings—ding ding—they have to look. Social media is almost like an addiction. I am sure that the companies love that because people are becoming so reliant on it. We need to make sure that our young people have varied lifestyles; that they get out and about in the fresh air, as my mum used to say. I am repeating my mother now. I hope she is listening. I never thought that I would get to that stage, but there you are, I am. It is important for health.
I am extremely pleased to have spoken in this debate. I am pleased that it has been given time in the main Chamber, where it should be, that we are prioritising mental health and that we are discussing the important issue of body image.

Kevan Jones: I begin by agreeing totally with the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron): the debate is important. Last week we had a debate on mental health; we have two this week, one here today and one in Westminster Hall on Thursday afternoon on the Mental Health Act 1983. That is good because the more we talk about mental health issues, the more we normalise them. The hon. Lady is right. I have been a Member of the House for more than 18 years, and it has changed. The more we talk, the better. She makes a very good point.
Ministers are going into the twilight zone at the moment; seeing whether they are going to come out of the reshuffle. I add my thanks to the Minister to those of my hon. Friend the Member for Dewsbury (Paula Sherriff). The Minister has been a passionate advocate for mental health and she deeply cares about it. We know when a Minister gets it, and she does. I hope that she survives whatever happens over the next few days. The other thing that is unusual and does not get a great  deal of publicity is the fact that she is prepared to work across party and across the House, and to listen to alternative viewpoints. I wish to put that on the record.
I pay tribute to the Mental Health Foundation for its excellent report. I know that the Minister was at the launch. I think it was the first time that body image and mental health had been brought together. The hon. Member for East Kilbride, Strathaven and Lesmahagow talked about eating disorders, and the stark facts that come out of the report should concern us all.
It is important to say that it is not just young people who are affected. As my hon. Friend the Member for Dewsbury said, 20% of the adult population in the UK feel ashamed of their body image and 34% feel down about it. In some cases, that will not lead to mental health problems, but in a lot of them it will. If people have anxiety about their body image, it leads to related conditions.
According to the report, 34% of young people feel upset about their body image and 31% feel ashamed of it. We cannot insulate young people from society—we should not even attempt to do so. Living in society can be difficult and challenging at times, and young people face the added pressure of social media.

Ruth Jones: I thank my right hon. Friend for making such a positive speech in this important debate. Does he believe that social media and advertising have a significant impact on young people, and does he agree that the Government need to take more vigorous steps to ensure that young people are protected from images that can lead them to form negative views of their own body?

Kevan Jones: I completely agree with my hon. Friend. I will go on to speak about the role of advertising because, as she will know, it has changed. When we were growing up, adverts were in magazines or on television. Now, they are accessible to young people 24 hours a day, seven days a week on smartphones and tablets. That has changed the pressure on young people, as is highlighted in the Mental Health Foundation’s excellent report.
Before I come on to advertising, I will touch on the issue of cosmetic surgery, which the Minister raised. Members may want to know why I am interested in the subject. It is down to a force of nature, my constituent Dawn Knight, whom the Minister has met. Unfortunately, several years ago a cosmetic procedure on her eyes led to the horrific situation that she can no longer close her eyelids. As the hon. Member for East Kilbride, Strathaven and Lesmahagow said, such procedures are not easily reversible. It is not like someone changing their hair colour and not liking it. The procedure has had a devastating effect on Dawn’s life. I pay credit to her, because she has been determined to campaign on this issue. I know that she has met the Minister on a number of occasions to highlight the dangers of cosmetic surgery.
The Minister referred to regulation. I have been calling for regulation in this area for five years. I do not think there is a lack of political will, and certainly not from this Minister, but I am told that the Department of Health and Social Care is so scarred by the Health and Social Care Act 2012 that it does not want to bring  forward any more health-related legislation. I say to Ministers that they must. This is the wild west because there is no regulation.
The Minister rightly warned people not to go abroad for such procedures, because standards are not high. Sadly, I have to say that they are not very high in this country either. Dawn’s case and the cases of numerous women that Dawn has documented over the years show that surgery that takes place in this country is sold like a commodity. It is not sold as something that could threaten or change people’s lives; it is sold like any other product. I am sorry, but it is not like any other product. Some of these procedures are very dangerous and can result in death.
The problem is the way the industry is structured. There are groups that give the impression that they employ surgeons and that they are hospitals. One that I have spoken about on behalf of Dawn and other victims—that is what I call them—is the Hospital Group. One would think that it is a hospital that employs surgeons and nurses, but it is not. It is a sort of marketing facility company that has a hospital and flies in surgeons from Europe, sometimes on a daily basis. They fly in, operate and fly out again. The aftercare treatment is non-existent in some cases. As Dawn’s case shows, when people try to sue the individual, they find that their indemnity insurance does not cover the resulting legal case.
What we need is a properly regulated system. The fly-in, fly-out surgeons need to be banned. I am sorry, but it is not acceptable. People say, “We have the General Medical Council,” but that is another of my hobby-horses. It is an organisation that is ripe for reform. The Government have promised reform of how the GMC operates, but they have not brought legislation forward. We need legislation to reform it because, as I will say in respect of another organisation in a minute, I am never a great fan of self-regulation. I was one of those who campaigned to take regulation away from the Law Society. Self-regulation has clearly failed. Nearly five years on from her complaint against the doctor, Dawn Knight is still fighting. It is not a user-friendly process for anyone to get redress for their complaint and we need to address that as a matter of urgency.
Cosmetic surgery is advertised and sold like any other commodity. There used to be two for one offers on Facebook and elsewhere—buy one procedure and get another procedure free. There were time-limited offers. Those should all be banned; they should not be allowed at all, because some of those procedures are very dangerous and people are often not aware of the dangers. I would argue that such a ban is part of the regulation we need. This is not a multimillion-pound industry, but a multibillion-pound industry and it is exploiting people’s poor body image.
Before anyone had any type of cosmetic surgery, I would insist that they had a mental health assessment. Not only should the risks of the surgery be explained, but we should question whether people actually want the procedure.
Advertisers use “Love Island” to promote the idea of young women having procedures to enhance their appearance. That reinforces the image that somehow there is a perfect body to be had, but also the idea that these procedures are risk free. Having spoken to Dawn  and other victims of cosmetic surgery, I know that these are not risk-free procedures. In many cases, they lead to mental health problems afterwards during the recovery process.
As the Minister rightly said, the ones who pick up the tab are us—the taxpayers. Not only do we pick up the bill for the correction of the surgery when these organisations fold themselves into new companies and go into bankruptcy, meaning that people cannot get any redress; we also pay for the mental health services for those individuals afterwards.
I say again that we need more regulation of advertising. The Advertising Standards Authority is a toothless tiger. The Mental Health Foundation’s report says that last year the ASA upheld a complaint against the producers of “Love Island” for promoting cosmetic surgery as part of the advertising package around the show. But anyone who has dealt with the ASA will know that it is slow and that it is not proactive. One of the report’s recommendations is that it should be proactive in looking at adverts in advance to ensure that they are pre-screened before they go out. Again, though, that involves self-regulation, and it does not work.
I accept that we have a Government at the moment who do not like regulation and who want to strip it out. We are possibly going to get more of that nonsense over the coming months from the new Prime Minister, but I take the clear view that the state needs to protect people when they are being exploited. On cosmetic surgery, I take the clear view that people who want to have cosmetic surgery have the right to choose what to do with their money, but they should have a fully informed choice rather than being pressured by glossy advertising.
Online advertising and body image have already been raised in the debate. We have heard about the way in which adverts and other images are photoshopped and that this is somehow a positive thing that every young person should look forward to. The Minister also mentioned Botox and fillers. Those procedures are not cosmetic surgery in the sense of people going under the scalpel, but I would argue that they are equally in need of regulation because of the appalling effects when things go wrong. According to some adverts, people can simply go along in their lunch hour and have a Botox or filler treatment and then walk away in the afternoon, but those are medical procedures. They are advertised on social media and elsewhere, but Botox is a prescription drug, and it is interesting that people seem to have access to it even though they have no qualifications at all. No qualifications are needed for injecting someone. Madam Deputy Speaker, I could inject you with Botox this afternoon—not that you need it—without any qualifications or training whatsoever. The Minister was right to say that the problem with the way in which social media algorithms work is that anyone who enters the term “Botox” into a Facebook search, for example, will then be bombarded by adverts not only for Botox and fillers but for training courses on how to administer them. People can actually sign up for those courses in order to earn money.
The only regulation around this is Facebook. Dawn Knight has raised the matter directly with Facebook, but I understand that the only thing anyone can do is to say to Facebook that they no longer want this on their feed and take it down. I have written to Sir Nick Clegg, who has now gone off to live with the beautiful people  in California, to ask him why Facebook is carrying those kinds of adverts and bombarding vulnerable people with adverts for Botox and other fillers. Those adverts have no disclaimers about risk, and there is no quality control over the individuals offering the services. As the Minister said, they could be people in hairdressers and other such places. Well, I am sorry, I know Facebook is earning money from those adverts, but it should ban them. I know that the vulnerability of young people is a matter of concern for the Minister, for Dawn Knight and for me. They could be getting access to these procedures without knowing the risks, and they are being targeted by the social media companies. I am waiting to see what response I get from Sir Nick Clegg and the beautiful people in California. Hopefully, they will take some action against this.
This is a serious issue, not just in terms of the way people are personally affected; it costs the taxpayer money when cosmetic surgery goes wrong and when people need mental health support. We also need regulation. We are all focused on Brexit at the moment, and perhaps this is another area that will not be addressed over the next few months. I hope that that is not the case, and I know that the Minister will continue to argue for this reform, as she has already done in Government. I also know that my constituent, Dawn Knight, will not leave this issue alone. I will not do so either, because people are putting themselves at risk and it is the duty of the Government to take action in Parliament to protect individuals when they need it. There is a lot of pressure on young people when it comes to body image. All I would say to those young people today is this: think positively, and be kind to yourself.

Wera Hobhouse: It is a real honour to speak in this debate, and I regret that not many people are here to participate in it, but as we know, today is today. Even though I have only recently become a member of Parliament, I echo the comments about what a pleasure it has been to work with the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), and I hope that she will continue in her post.
We have talked about many issues, and I want to pick up on what has been said about the cynicism with which advertising exploits vulnerable people. I will be speaking mostly on eating disorders, and many victims of eating disorders already have a massive problem, even before they go online. If they then order slimming pills online, for example, they will be bombarded by adverts persuading them to buy even more, which they then do. That is nothing short of exploitation, and we need to be alert to that.
We are all ultimately affected by our body image. People might say to me, “Well, you look all right”, but we all think, “Well, this could be better and that could be better.” We all want to please the people around us and ourselves when it comes to what we look like, and that is nothing new. It is only unusual or harmful when it so negatively affects us that it is the only thing that guides our lives. There is a certain intolerance surrounding having to have a particular look, and that is where the real danger lies. People feel they have to look in a particular way rather than feeling that it would be fun to look this way or that way and to be playful with what  they look like. Instead, they are being shoehorned into a particular image, and anyone who does not fit that image can be badly affected and develop serious mental health problems, including eating disorders. I have been campaigning on the particular issue of eating disorders and mental health.
This debate is important for millions of people across the country, and I hope that we can set an example today by honestly exploring the issues. In fact, I think we already have. In a culture that is obsessed with image, we must talk more openly about the impact that body image scrutiny has on our mental health. It has been said before that we are focusing too much on how we look, rather than on who we actually are as people and what we can bring to the table, whether we are short or tall, male or female. That is one of the obsessions of our society: we are always thinking about what we look like, rather than about who we actually are.
For the past year, I have been campaigning for better treatment for eating disorders. Speaking openly about such conditions is more important than ever, because early identification and intervention are key. Mental health conditions thrive in the shadows and are protected by our ideas about what is and is not appropriate to talk about. Eating disorders have a reputation, and sufferers who do not fit cultural stereotypes are often afraid to speak out or, worse still, are refused help.

Kevan Jones: The popular image of eating disorders is that they mainly affect young women, but does the hon. Lady agree that young men and people of all ages are increasingly likely to be affected?

Wera Hobhouse: The right hon. Gentleman is absolutely right, and that has been explored in several debates  on eating disorders. We are somewhat hemmed in by stereotypes, and I wonder whether our age is particularly prone to that. We think eating disorders are a particular thing, so for a long time they have been a problem for young girls, but they affect people of all ages, and men increasingly. As we have explored today, body image and mental health are not gender-specific, but men suffer in silence more, because they are much less likely to talk about things, and subsequently they seek help a lot later, which can be dangerous. In fact, it is well known that the highest number of suicides are among men between the ages of 18 and 25, because men—this is a cultural stereotype that we can hopefully overcome—just do not talk about their body image, anxieties and mental health as much as women.
Research by the Mental Health Foundation published last March shows how common it is to have body image concerns, and we have heard many other statistics today. One in five UK adults have felt anxious or depressed about their bodies in the past year, and that anxiety can turn into long-term mental health problems, such as eating disorders. Across the country, eating disorders affect 1.25 million people, which is probably a conservative estimate. My work in this area supports that suggestion, and the sufferers that I have met come from a range of different backgrounds, but they are united by their dissatisfaction with, and need to control, their body image. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) has already talked powerfully about that.
Of course, eating disorders are far more complex than stress over body image. They are serious conditions that ruin, define and, all too often, end lives. However, the seeds of emergent eating disorders can often be spotted in stress or anxiety about body image. For the more than 1 million people who were identified as having an eating disorder, the outlook is not good. On average, it takes 85 weeks between someone realising they have an eating disorder and that individual receiving treatment. That lost time can be the difference between full recovery and living with a permanent disability or disorder. The Government targets introduced to limit child waiting times for eating disorder treatments were a positive step, but thousands of adults across the UK need the same measures. We need to consider the waiting times for adult sufferers of eating disorders, and I know that the Minister has already looked into that.
Understanding eating disorders better is key to improving treatment. Many sufferers still report being turned away and refused referral, because doctors have told them that they are not thin enough to be treated for an eating disorder—I know that the Minister has talked to Hope Virgo, who has been running the “Dump the Scales” campaign—but an eating disorder is not just about someone’s body mass index. By talking about eating disorders, especially in the context of body image, we can start to grasp how damaging that can be. We must educate everyone, from sufferers’ families to doctors, about the many different forms that such conditions can take and how best to treat them. Eating disorders have the highest mortality rate of any mental health condition, and our mental health policy must reflect that. This is a crisis, but we are not treating it as such.
Early intervention is key. Schools, doctors and support workers must be equipped with the tools to identify when body image concerns are becoming dangerous. Furthermore, we must change the cultural conversation around body image, which can be done on many levels. As we have already heard today, social media companies have a responsibility to police the content on their websites, ensuring that anything that actively incites self-harm is taken down. Eating disorders are on the rise, and many adult sufferers are failing to receive the early intervention they so desperately need. We must do better for those suffering in silence and start having a conversation about body image, mental health and the awful reality of life with an eating disorder.

Sharon Hodgson: I think we can all agree that this been an eye-opening and interesting debate, and I start by thanking all the hon. Members present for making such excellent, personal and candid speeches. I also want to continue the theme of hoping that the Minister will still be in her position at the end of the day, because, as everyone has said, she really takes on board the cross-party consensus on many such issues, doing so with regard to the matter rather than the politics. On these things, there is always more we agree on than we disagree on. Having reinforced her embarrassment, I will now move on.
Today we have heard about the impact that negative body image can have on people’s mental health, and I will particularly address the mental health of children  and young people. It is clear that more needs to be done to promote healthy body image, which should start as early as possible.
I pay tribute to the Mental Health Foundation for its comprehensive research and campaigning on this topic. It has found that even children under the age of six have reportedly felt dissatisfied with their bodies, so promoting a healthy body image from an early age is therefore a crucial step. It is obvious from what we have heard today that more needs to be done to ensure that happens.
It is heartbreaking to hear that more than half of children and young people have been bullied because of their appearance, and that one third of teenagers say they have felt shame because of their body image. The Children’s Society has found that children’s happiness with how they look has not improved since the mid-1990s, and young people themselves say that body image is their third biggest area of concern in life, after their education and employment prospects. Why, then, are we failing to address poor body image when it is such a crucial issue?
It is clear that educating young people about their bodies is an important step in improving their body confidence, so do the Government have plans to ensure that schools cover body image concerns as part of the introduction of compulsory relationships and sex education in 2020? More needs to be done to promote healthy body image and good mental health among our young people.
Classroom-based teaching should not only extend to teaching children about their bodies; more needs to be done to ensure that children understand how to use social media safely, understand how to improve their self-esteem and understand their emotions. Can the Minister outline how the Department for Education is tackling these issues in schools? I know the Minister is here representing the Department of Health and Social Care, but the Under-Secretary of State for Education, the hon. Member for Stratford-on-Avon (Nadhim Zahawi), the Children’s Minister, was here a moment ago, and they should be in close contact on this.
Children who are concerned about their body are less likely to take part in physical activity. We can all remember our school days, and I am sure we were all concerned about that. This is concerning when we know the health benefits of physical activity, so promoting positive body image can have benefits for physical health, as well as for mental health.
The mental health consequences of poor body image can be severe. Although having body image concerns is not a mental health problem in itself, having such concerns can be a risk factor for mental health problems. Mental health support should start where children need it, which is in school. Can the Minister tell the House what interim funding has been offered to schools to provide mental health support, given that the Green Paper’s proposed support package will not be rolled out nationally until 2023? Schools really cannot wait another four years for this support because, as we know, they are already struggling with their current budgets.
Where mental health problems develop, early intervention and support from mental health services is crucial. Too many young people who are not able to access the mental health support they need from child and adolescent mental health services are left waiting for treatment on  waiting lists for far too long or are turned down for help because their condition is deemed to be not bad enough. The best way to stop our young people developing eating disorders is to make sure they do not have to wait until they have an eating disorder and until they are bad enough to get that help. For children and young people who need support from CAMHS, there needs to be specific support to help them with body image concerns. What are the Government doing to ensure that support is in place?
According to a survey of family doctors, nearly all GPs worry that young people with mental health problems will come to harm because of difficulties in accessing treatment on the NHS, which should absolutely not be the case, and I know the Minister agrees. As was said at Health questions earlier, it is time to ring-fence funding for children’s mental health budgets to ensure that mental health services for children are properly funded.
I have spoken mostly about the impact on children and young people, because it is vital that the causes of poor body image are addressed early to ensure that children and young people think positively about their bodies and therefore go on to think positively about their bodies as adults. People with long-term conditions, such as cancer, and new mums can also have particular body image pressures and concerns, so it is important that as well as mental health services, other health services are there to support people when that is required. In some other cases, the issue is not due to mental health but can become a mental health issue if the matter is not addressed earlier.
According to the Mental Health Foundation, cognitive behavioural therapy—CBT—and other talking therapies can help people who are struggling with body image concerns, but we know that access to talking therapies can be a bit of a postcode lottery. Will the Minister explain how the Government plan to try to end that postcode lottery?
It is worrying to hear about body image concerns among lesbian, gay and bisexual people. One third of adults who identify as lesbian, gay or bisexual have reported experiencing suicidal feelings in relation to their body image. It is therefore important that lesbian, gay and bisexual people have access to support that is tailored to them. Has the Minister taken steps to ensure that lesbian, gay and bisexual people have access to appropriate mental health support?
As we know, trans body image is often linked to a specific condition called body dysmorphia, which means it is not included in the statistics I just mentioned. Trans people face specific challenges in accessing mental health support, so it is vital that the Government ensure that mental health support tailored to trans people is available throughout the country. Will the Minister explain what steps the Government are taking to provide mental health services for trans people in this regard?
We have heard today about the profound impact that social media, celebrity culture and advertising can have on young people and adults and their views of their bodies. Too often, the content shared on social media is having a negative impact on mental health. That is why it is vital that more is done to protect children and young people and vulnerable people online, including from harmful images that can affect their body image. Far too often, social media companies turn a blind eye to harmful content. More really does need to be done to  stop such content appearing online. I commend my right hon. Friend the Member for North Durham (Mr Jones) for mentioning Facebook, as well as a former Member of this place and what he might be able to do in that regard.
I am reminded of all those pro-ana websites. I never even used to know what pro-ana meant—I did not realise it was even a thing—but when I see some of those websites and some of those YouTube stars, and the sort of body image that they present as being obtainable and the norm, I think more really should be done to take those images down. I also include in all that the fact that the movie world, Hollywood, TV and Netflix have a responsibility to promote a healthy body image when they cast their shows and movies. I will not name any particular show, movie or artist, but I have in mind a particular example of casting that really does, in my opinion, promote a very wrong body image. That does cause harm. The harms caused online need to be seen and treated as public health concerns, which, as shadow public health Minister, I am passionate about.
Labour is calling for a regulator with teeth that can take serious action against social media companies and for an enforceable duty of care to deal with the harms, hate and fake images that many online companies allow to flourish on their platforms.
The Government heeded Labour’s call and announced a regulator in the “Online Harms” White Paper, which is great, so it is now imperative for a regulator to be put in place as soon as possible. Will the Minister let the House know when that regulator might be expected? The process might take many months, and meanwhile children, young people and vulnerable adults are left at risk of severe online harms. The Government need to move faster and to go further, and perhaps we might see that under the new Administration—who knows—but it is clear from this debate that more needs to be done to tackle harmful content and body stigma, and to provide appropriate mental health support for everyone who needs it. Following this debate, as we have all said, I hope that the Minister will still be in her job and able to tackle this.

Jackie Doyle-Price: I shall not detain the House for too long, because I think it has heard enough from me for one day. I thank Members for their generous comments, even if they might be career-limiting.
In this debate, however, there is consensus across the House. We all fully recognise the problems that we face and the need for decisive action to tackle them. I will certainly continue to work with all Members to do exactly that, because this is too important and—I make this observation—the people out there expect us to work together more often than not. Such subjects should not be a political football, and it is too important to ensure that we are tackling harms.
The hon. Member for Dewsbury (Paula Sherriff) made the observation that the debate might not be as well attended as previous ones, but to be fair we have had many such debates in this space. Many Members, even if not present this afternoon, clearly have a keen interest. I am utterly at one with her when she expressed her concern about a context in which we have normalised unrealistic body image. Such images have become so  normalised that it will take a lot of effort to address it. She also referred to the incident of the lady who, sadly, died as a result of accessing a Brazilian butt lift from a surgeon in Turkey. Unfortunately, she is not the only such person from this country. It is the most dangerous cosmetic procedure that can be undertaken and, as a consequence, is banned in this country. None the less, despite the ban, people are still bombarded with images and with adverts for where they can seek the procedure. That brings home the fact that we need to do much more to make people aware of the risks.
Many Members referred to the influence of advertising, and I am afraid that those organisations that profit from hosting advertising ought to have a duty of care and ensure that the material they carry does not expose people to harm. I therefore welcome the engagement that the right hon. Member for North Durham (Mr Jones) is undertaking with Facebook on exactly that. It is not good enough for social media providers to retreat to the defence of, “Well, we are a liberated platform, regulated by our users.” Where they become a vehicle for things that will cause harm, those social media providers have a duty of care to the people who use their platforms. We must all continue to challenge them on that issue.
We have had lots of references to “Love Island”. Collectively, perhaps we ought to challenge use of the term “reality TV”, because it is not reality TV; it is fantasy TV. [Hon. Members: “Hear, hear.”] So that might be the outcome of today’s debate—let us all talk about fantasy TV from now on, because such programmes promote lifestyles that are not normal or achievable. Let us do that.

Kevan Jones: Will the Minister challenge the producers of a show such as “Love Island” to produce a series with real people in it, rather than one with the image that they are trying to portray now?

Jackie Doyle-Price: I could give that challenge, but the sad thing is that I do not think that any of us would watch that—although I do not think that many of us watch it now. Frankly, I like my dramas gritty and real. Ultimately, ITV broadcasts “Love Island” because it attracts many viewers—many of them among the most vulnerable group we are talking about. Again, ITV should be much more responsible, although the show is one of its biggest earners. I just regret the fact that we have become such a nation of voyeurs, and we all need to reflect on that point.
It is interesting that, because the people in these so-called reality TV shows are not known to us—they are not celebrities—we do not really see what we are doing to them in these circumstances. I do not know whether any hon. Members used to watch “Big Brother”, but there was an occasion when a contestant on “Celebrity Big Brother” effectively had a meltdown on TV. The public reaction then was very different; I think it seemed more real to people because it was a celebrity and the public were invested in them. That illustrates just how pernicious these so-called reality TV shows are, with their anonymous celebrities. These people suddenly become very exposed, and we have seen the outcome for some people’s mental health when they re-enter the real world.  I know that ITV has reflected on some of those risks, but there is much more to do. As I said, let us start calling them fantasy shows.
The hon. Member for Dewsbury also mentioned the whole issue of body shaming online. We have accepted as normal some really unpleasant behaviour online. I always use the example of drinking and driving. It did not matter that drinking and driving was made illegal; it was only when it became socially unacceptable that people really stopped doing it. We need to get to that stage when it comes to how people behave online. Again, this happens because people do not see others as real people online. When people make abusive comments online, it is because they feel that they are able to. That has got to stop and we need to lead the way.
The hon. Lady also asked what it takes to make the social media companies actually do something about this. In the context of suicide content, it took a death—and it should not take a death. With regards to other content, I suspect that it will also take deaths to get these companies to do something. That really is not good enough. I pay tribute to those who are brave enough to share their experiences of self-harm and suicide as a result of what they have seen online, because they are really helping us to drag the social media companies to where they need to be.
The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I never pronounce it right—articulated the fact that this area is an artificial world that becomes more and more intense. When we start using the internet and looking at things on social media, we do find ourselves dragged into a deeper and deeper world of “like” content, and it is easy to cease to be objective in those circumstances. We have certainly seen that with regard to self-harm and anorexia sites; it is just constant. The journeys that some people have been through are akin to grooming. People can find themselves being groomed by online content by sheer accident. Given that context and given how we use devices these days, it is not difficult to see why people are becoming much more exposed to such risks. Safe ways of using the internet—using iPads and so on to access content—has to be central to any education we give children about looking after themselves because that level of intensity clearly causes harm.
The hon. Members for East Kilbride, Strathaven and Lesmahagow and for Bath (Wera Hobhouse) talked about eating disorders, the clinical pathways available and out-of-area places, all of which are issues that really bother me. It has to be said that we have done well on children’s access to help with eating disorders—and I think it was right to do so because if we can tackle these issues early with children, we are tackling eating disorders—but it has highlighted the risks that exist when children cease to be children and become adults. The level of service is not as good when people enter adulthood, particularly through the whole period of transition, and that in itself can cause harm. We have heard about Hope Virgo’s #DumpTheScales campaign and the fact that different clinical standards are being applied for children and adults. That is clearly something that we really need to fix and it is a key priority for me.
I also fully recognise the danger of out-of-area placements for people with eating disorders. Part of people’s recovery has to be the relationships that they have with family and friends. I have seen that very clearly with children  and young people. Generally, we need to reduce the number of out-of-area placements for people with acute mental health issues, including eating disorders, but I will not be satisfied until we have no out-of-area placements at all. Having people long term in beds in hospitals is not good for their mental health. Clearly, there are cases where there is a need for intensive treatment and we need to do that, but over time, out-of-area placements really should not be a thing.
The right hon. Member for North Durham, as usual, brought to the debate his very well-informed knowledge of this subject. I join him in paying tribute to Dawn Knight and all the campaigning she has done. She has not been shy about sharing the devastating impact of what she did, telling her story of how she just wanted to enhance her appearance and the result has been absolute hell. Neither is she shy about sharing exactly what the impact will be on the NHS as a consequence of the treatment she has had to have to put it right.
This whole area of cosmetic surgery is growing very quickly, and people are quite naive in thinking that perhaps the more money they spend on a procedure, the better it is going to be. Nothing could be further from the truth, because there are the least virtuous of people in this space. As the right hon. Gentleman says, this is the wild west. These people are profiteers. Part and parcel of enabling people to protect themselves in this environment is to really talk about the risks. There are some absolute cowboys out there. The story that Dawn tells about trying to sue the practitioner who undertook her procedure shows that that is frankly impossible. When people want to become engaged in activity that is borderline criminal, they find ways of making sure that they cannot be held to account for it. Whatever our instinctive view about people’s choice, self-regulation and so on, where there is clear evidence of harm, the Government should act. We really must look at this more seriously. I am happy to continue speaking to Dawn and to the right hon. Gentleman about that.
Clearly, we need to look at the whole issue of dermal fillers. It is classed as a medical device and therefore is not on prescription, but ultimately something is being injected into the face, so we need to make sure that we are doing something about regulation. The right hon. Gentleman mentioned the role of the GMC. As he says, Botox is a prescription drug, but it is clearly being administered by people who are not practitioners. Both the GMC and the Nursing and Midwifery Council have an obligation to uphold their regulatory standards. If someone is using their prescribing power irresponsibly and not being present when the product is administered, then action should be taken, and I shall expect those bodies to do that.

Kevan Jones: I agree with what the Minister says, but if we look at some of the adverts—for example, on Facebook—there is no way that people who are signing these prescriptions can actually be present. Her Department should look at this area, because there are clearly people signing prescriptions and then either selling them on for a profit or giving them to people to make money out of these procedures.

Jackie Doyle-Price: I am grateful to the right hon. Gentleman for amplifying that point, because we must do that. We give very clear indications that we expect  the NMC and the GMC to deal with this. However, we must also send a message to people out there that people will get these adverts about how to become a dispenser of dermal fillers and think that that is all they need to do, having no idea that they are committing a criminal offence. We need to educate them as well.
I will end there, because, as I say, I feel like I have been the Government at the Dispatch Box today. I look forward to continuing discussions with all Members present, who I know care very deeply about this. It is something that we really must tackle as a matter of urgency.
Question put and agreed to.
Resolved,
That this House has considered body image and mental health.

Rosie Winterton: I call Tom Tugendhat.

PETITION - STONECASTLE FARM QUARRY

Thomas Tugendhat: It is a great pleasure to be here, with you in the Chair once again, Madam Deputy Speaker.
The petition of residents of Tonbridge and Malling declares that Stonecastle Farm Quarry near Golden Green is an unsuitable location for further quarrying, and that Kent County Council and the Planning Inspectorate should not allocate site M13 for sharp sand and gravel extraction in the Kent minerals and waste local plan.
I am particularly grateful to all the residents in Golden Green and surrounding villages, including some of those present in the Public Gallery today—the advancement of public business may mean that some of them have not made it—for their work in collecting signatures and responding to the consultations that have already taken place. Including online signatures, over 1,000 people have now indicated their opposition to the allocation.
Stonecastle Farm Quarry lies on the boundary of Tonbridge and Malling with Tunbridge Wells. I know that my right hon. Friend the Member for Tunbridge Wells (Greg Clark) endorses my comments today, and perhaps he will be able to speak more freely about them tomorrow. Residents in Tudeley and surrounding areas, including the Save Capel campaign group, have been actively campaigning against expansion here, and against other proposed developments in the area. I hope the House will recognise their efforts.
The petitioners therefore request that the House of Commons urges Kent County Council and the Planning Inspectorate to reconsider the allocation of a site for quarrying in Golden Green.
Following is the full text of the petition:
[The petition of Residents of Tonbridge and Malling,
Declares that Stonecastle Farm Quarry is an unsuitable location for further quarrying and Kent County Council and the Planning Inspectorate should not allocate site M13 for Sharp Sand and Gravel extraction in the Kent Minerals and Waste Local Plan.
The petitioners therefore request that the House of Commons urges Kent County Council and the Planning Inspectorate to reconsider the allocation of a site for quarrying in Golden Green.
And the petitioners remain, etc.]
[P002500]

PETITION - WINDRUSH

Dawn Butler: The petitioners, including the change.org online petitioners—almost 12,000 people in just a few days—call on the Prime Minister, who has 24 hours to rescue her legacy, to resolve the outstanding Windrush cases. There is still time to right the wrongs of Windrush. The Prime Minister can stop the dehumanisation and humiliation of the hostile environment. We call on the Prime Minister to declare an amnesty and ensure that all who entered as British citizens and came to the motherland to help rebuild her after the war have their British citizenship reinstated.
The petitioners therefore request that the House of Commons urges the Prime Minister, the right hon. Member for Maidenhead (Mrs May), and the Government to resolve all outstanding Windrush cases by Wednesday 24 July.
Following is the full text of the petition:
[The petition of Residents of the United Kingdom,
Declares that the Prime Minister has spoken at great length recently about her legacy; further that if she leaves office before resolving the Windrush scandal and the many outstanding cases, then this will be her legacy; further that the Prime Minister should offer more than warm words and take action to solve the crisis she created; further that in 1948, individuals throughout the British Empire received citizenship under the British Nationality Act; further that these citizens, some from the Caribbean, came to the United Kingdom in order to help rebuild the country after the war; further that these citizens lived here, worked here and raised families here; further that the hostile environment policy accelerated during Mrs May’s time as Home Secretary led to many of these citizens losing their rights and in some cases being deported back to the Caribbean; further that others lost jobs, were forced into debt and suffer from immense stress and fear because of the policy; further that the former Home Secretary Amber Rudd said in April 2018 that it would only take two weeks to resolve the Windrush cases, however over a year has passed and there is still a significant number of outstanding cases; further that what has been done to these British citizens is outrageous, unfair and must end; further that a change.org petition initiated by Dawn Butler MP on this matter has received over 9,600 signatures.
The petitioners therefore request that the House of Commons urges the Prime Minister Theresa May and the Government to resolve all outstanding Windrush cases by Wednesday 24th of July.
And the petitioners remain, etc.]
[P002502]

Lower Limb Wound Care

Motion made, and Question proposed, That this House do now adjourn.—(Jo Churchill.)

Ann Clwyd: As you know, Madam Deputy Speaker, I do not normally sit when I speak in this place, but half an hour ago I was in a hospital bed on the 12th floor of St Thomas’s when I heard that this debate was coming early, rather than later. There was a big rush to get me here, and there are very good doctors and nurses in the Gallery who helped me to get here, because I thought it was tremendously important to speak. I had secured this debate, for which I am very grateful, and I particularly wanted to talk on this subject. I was pleased to get it before the recess, and I was not going to miss it for anything. After we finish, I shall be returning, I hope, to the 12th floor of St Thomas’s and to very good care.
The subject of this debate was brought to my attention by Lord Hunt, our colleague in the House of Lords, where they had a debate not long ago about what plans the Government have to develop a strategy for improving the standards of wound care in the NHS. As somebody who needs wound care right at this moment, I know what a big subject it is. I did not know before—I was totally ignorant—but I have discovered what a challenging subject it is for so many people.
As a patient myself, I can talk about the subject with some feeling. I have to say that it is the most painful thing I have ever come across, and I had no idea that people suffered this kind of pain. A week ago, when I had to be taken to a local hospital in Merthyr Tydfil,  I was asked by an ambulance driver what level of pain I was in, on a scale of one to 10, and I said, “Nine.” I do not usually exaggerate; it was that painful. I am grateful to everybody who has helped me, and I want to make sure that the service develops and people get all the help they need in such circumstances.

Jim Shannon: I congratulate the right hon. Member for Cynon Valley (Ann Clwyd) on securing the debate. She often features in Adjournment debates in this House. We are very pleased to see her in her place, and we thank her for all that she does. Does she agree that many people fear that the NHS neglects leg ulcers and the required treatment is not being given? The latest statistics, according to Dr Adderley’s speech at the Health Service Journal patient safety congress, show that leg ulcers account for 40% of chronic wounds but only 7% of the chronic wounds that are treated. There is quite clearly an anomaly.

Ann Clwyd: I am grateful to the hon. Gentleman for making my speech for me. I am sure we will be in total agreement as my speech develops.
Some interesting points were made during the debate in the other place, including the point that wound care is a massive challenge to the NHS, but it currently lacks priority, investment and direction. I want to push the Government, if they need pushing, on the need for urgent action and the development of a strategy across care providers to improve the standard of wound care.
A staggering 2 million patients are treated for wounds every year, at a cost of more than £5 billion and rising. While 60% of all wounds heal within a year, a huge   resource has to be committed to managing untreated wounds. The NHS response is very variable. Healing takes far too long; diagnosis is not good enough; and inadequate commissioning of services by clinical commissioning groups compounds the problem, with under-trained staff and a lack of suitable dressings and bandages.
There has also been a very worrying drop in the number of district nurses, whose role in ensuring safe and effective wound care in the community is crucial. I was shocked when I talked to a friend in Cardiff about the problem of putting on surgical stockings, and her experience highlights the need for district nurses. My friend had had a serious operation, and she could not bend to pull on the stockings. I asked her what she did, because she is a widow who lives on her own. She said, “I go out in the street and ask somebody to help me.” I am sure that people are very ready to help, but no one should be in that situation. I think we would all agree that the drop in the number of district nurses is very worrying.
I am told that, ideally, 70% of venous leg ulcerations should heal within 12 to 16 weeks, and 98% in 24 weeks. In reality, however, research shows that healing rates at six months have been reported as low as 9%, with infection rates as high as 58%. Patients suffer, and the cost of not healing wounds swiftly and effectively can lead to more serious health problems, such as sepsis, which is often the result of an infected injury. We also know that foot ulcers on diabetics can unfortunately lead to amputations if they are not dealt with properly.
In the other place they talked about the Bradford study, and there is a very good summary of it in the House of Lords Library. It underlines the importance of evidence-based care, with nearly one third of patients interviewed in the study failing to receive an accurate diagnosis for their wound. As the study puts it:
“Wound care should be seen as a specialist segment of healthcare that requires clinicians with specialist training to diagnose and manage…There is no doubt that better diagnosis and treatment and effective prevention of wound complications would help minimise treatment costs”.
We learn most of all from our own experience. My experience is that when I first developed a farthing-sized spot on my leg, I did not know what it was. I asked my chiropodist, who looked at it a few times and said, “I think you had better go and see your GP.” I went to see my GP—a very good GP—who did not know what it was either. Eventually, I was referred to a skin specialist—this is some weeks ago, now—who looked at it and said, “I don’t know what it is, but why don’t you try putting Vaseline on it?” Now, I do not think the experts up there in the Gallery would think that that was a very good idea, but I did put Vaseline on it and I do not know whether that did me any harm or not. You do worry a lot when something like that happens, whether you have knocked your leg or injured yourself in some other way, and you wonder what on earth it could be.
I think that maybe diagnosis is difficult, but rapid diagnosis is absolutely essential. I am sure the Government would agree that we need to get to grips with a nationally driven strategy. Without it, patients will receive worse care for their injuries and the financial burden on other parts of the NHS will continue to increase, because patients develop chronic wounds or catch an infection that could lead to life-threatening illness.
During the course of my journey, I have met many interesting people. For instance, I did not know there was an all-party group on vascular and venous disease. I just happened to see it in the all-party notices the day after I had been in St Thomas’s. I rang up the chair, the hon. Member for St Ives (Derek Thomas), and asked him if I could come along to a meeting. He said that I was welcome to. I went along and, apart from the chair, I think I was the only MP there. There was a fascinating mixture of people, who were all involved in this problem in some way.
There was somebody who runs a leg clinic, who had a lot of stories to tell. In fact, she sent me a whole pile of patient stories—there is not time to read them out today, but they are very interesting. I realised how difficult it is for patients to get the right diagnosis and the right treatment. I took a list of all the people—they are mainly consultants—and I know that some people in St Thomas’s would have come along if they had known of the existence of such a group. It introduced me to the Lindsay Leg Club Foundation, which is run by Ellie Lindsay OBE, who is the president. There are leg clubs in many towns and cities around the country. She was very encouraging—I say that as somebody who was a bit afraid when they realised what they had. She rang me up several times, and her patient stories were fascinating.

Jamie Stone: I am listening with great interest to what the right hon. Lady is saying, not least because this is an important debate on something that we do not talk about as much as we should in this place. Am I picking up correctly what she is saying on patient experience? Is she saying that we should encourage patients who have been through this transition and experience to share that experience with others in order to make other potential patients more aware of what might be out there and what they could do?

Ann Clwyd: Yes. That is a very positive idea. People need to talk to one another, particularly in this House because of the age differences. A lot of people talk about this in the other House, because on the whole they are much older than we are—except for me in this place; I am pretty old. I am just surprised that I had never heard of this before. Talking encourages people when they have discovered that they have this problem to seek the right advice.

Jamie Stone: Can I make absolutely sure that I understand this? By age difference, the right hon. Lady means people of my age—I am considerably older than some hon. Members—sharing experiences with people who are younger and might need to know these things. Is that correct?

Ann Clwyd: Sorry; I did not hear the last part.

Jamie Stone: Is this about the older generation, who might have had some experience in this regard, sharing experiences so that the younger generation—considerably younger than I am—might know the potential of what they will look at or deal with in future?

Ann Clwyd: Yes. I am very glad that there is an all-party group, for example, because it is important that such groups exist. I have seen the work that has   gone on there over several months. As the hon. Gentleman knows, there are dozens and dozens of all-party groups in this place—I am sure that we do not know of the existence of most of them, but it is good to draw attention to this one.
Another person I met was Professor Julian Guest, who is a health economics consultant. People are very good at sending information. He sent me a list of things that, as a health economist, he has been working on. He says that wound care requires
“a change in its service delivery model that could include…Enhanced support for safe self-care (possibly by integration with local pharmacy support and supervision)…Improved diagnostic support underpinned by increased training and education of non-specialist nurses in the fundamentals of wound management…Consistent and integrated progressive care pathway with agreed defined trigger points for senior involvement and onward referral for investigation and differential diagnosis and a shared management plan to be implemented regardless of care setting…Establishment of dedicated wound care clinics in the community, possibly in general practices.”
So there are several papers by people working in this area who are thinking deeply about it.
I heard from consultants at St Thomas’s about an excellent development called the Camden Health Improvement Practice pilot wound clinic. Dr Geraghty, who runs it, is working on wound care for people who are sleeping rough—for the homeless. I think everybody would applaud that as a very necessary and useful thing to do, and we look forward to hearing more about it. I am looking at the clock, and there is not much time left, but I hope the Minister will respond on this issue, because when I think of the pain inflicted on people—luckily, my pain is managed, but the pain of the homeless, for example, who are sleeping rough on the streets, is not generally being managed—it is clear that this Camden project is a very welcome development.
I had a new knee about a year ago, which is not a pleasant thing to have done. However, I have known nothing as painful as this leg wound, and I am grateful that so many good people are working in this area and highlighting its importance. It is probably not as glamorous as others in the health service, but it is absolutely necessary for people’s wellbeing, comfort and health, and I hope we can do a lot more to support people in this area, to support new initiatives and to assist the doctors, nurses and other practitioners who do such an excellent job.
I am out on parole, Madam Deputy Speaker. I will, I hope, be returning to my bed in St Thomas’s before too long, and I hope to come back after the recess with very positive views and a continuing interest in the whole subject of wound care in the NHS.

Caroline Dinenage: It has sometimes been said that MPs in this House speak about things they do not know about, and sometimes MPs speak about things about which they have only a little experience, but I do not think I have ever had the honour of responding to a debate where a Member has spoken with so much current, relevant experience. I must congratulate the right hon. Member for Cynon Valley (Ann Clwyd)—

Ann Clwyd: It is pronounced “Cun-on”

Caroline Dinenage: I do apologise—I went to university in Wales, so I should get that right.
I must congratulate the right hon. Lady, first, on securing the debate, and, secondly, on making such mammoth, gargantuan efforts to be here. She did that with some help from her friends on the 12th floor of St Thomas’s, the experts in the Gallery—I am going to have to be careful what I say. She is nothing short of an inspiration to all of us, both as a long-standing Member of Parliament who is greatly respected in this place and as a human being. We are so grateful for the fact that she has made it here today, and we wish her a very speedy recovery. We look forward to her being back here to monitor every development that the Department can bring about in the context of wound care and how we look after people in hospital more generally. She is a great inspiration to all of us, and I thank her so much for raising this issue in the House.
I think we all recognise the importance of ensuring that patients have access to high-quality lower limb wound care. As a Government, we are absolutely committed to ensuring that people receive the right care in the right place at the right time, whether through acute services,  a local GP or services based in the local community. As the right hon. Lady knows, wound care treatment  is a vital service which, during the initial period, is predominantly provided by a community nurse. That crucial provision offers relief to those with leg ulcerations or diabetic foot ulcerations and pressure ulcers.
As Members will know, venous disease is the most common type of leg ulceration, and can cause great distress and suffering to patients and their families. The right hon. Lady spoke powerfully of the pain that she has suffered, and that others suffer, as a result of the condition. I think it is important to keep that in mind because of the side effects that having to live with enduring pain for long periods can have on a person’s emotional and mental health and wellbeing.
Our priority is for leg ulcers of this type to be treated early and in the community when that is possible, without the need for further hospital admissions or GP appointments. I think that that preventative approach is right for patients and for the system. It is key for wound care to be delivered effectively and efficiently. Good wound care not only saves patients from distress and suffering, but gives nurses more time to deliver other important services, and alleviates pressure on acute services. That is why NHS England and NHS Improvement have commissioned the Academic Health Science Network to develop and deliver a national wound care strategy programme for England, which aims to improve the quality of wound care provision. It is a comprehensive programme, which covers improving prevention of pressure ulcers, wound care of the lower leg, and management of surgical wounds.
The programme’s work will be informed by the following priorities. First, it will improve patient experience and outcomes by developing national clinical standards of care and a more data-driven approach. I know that the right hon. Lady is very keen on that. Secondly, it will work with industry to ensure that the right wound care products are reaching patients at the right time through the development of a much more robust supply, delivery and distribution model. Thirdly, it will aim to improve the current patchy provision of wound care training—of which I know the right hon. Lady is well aware—and  the inconsistencies in the availability and quality of educational resources. As well as improving the care provided by healthcare professionals, that will allow patients to become more capable in self-care.
The right hon. Lady raised several issues that I should like to follow up. Let me first pay tribute to the work done by the Lindsay Leg Club Foundation in relation to community-based leg ulcer care. I am pleased that the committee of the lower limb clinical workstream of the national wound care strategy programme includes members of the foundation. As the right hon. Lady said, leg clubs are organised by the local community rather than health providers, but leg club nursing teams are employed by NHS local provider services, clinical commissioning groups and GPs. That is why it is so important for everyone to work together to support people as much as they can in the community. I can imagine that when this condition starts it is so painful that people can feel extremely alone and isolated, and the provision of leg clubs and other support mechanisms in the community, to offer the information, advice and support that they need, can help them to stop feeling that isolation and fear.
I also join the right hon. Lady in welcoming the all-party parliamentary group on vascular and venous disease. It is important for us to have all-party parliamentary groups which really recognise conditions of this kind, and which are doing their best to push the Government, and us in the Department of Health and Social Care, to do everything we can to support people who suffer from them.
The programme that I was talking about started its work in late 2018, and since then has brought together a range of experts. It has recruited over 500 stakeholders from a very broad range of private and public sector organisations to its stakeholder forum, and it is important that we have people with real experience from across the country taking part in this and influencing the decision-making. They aim to deliver their recommendations by the end of the 2019-20 financial year. We look forward to receiving them and the positive impact that they will have on patients’ lives. This is just for England, but NHS England is in communication with wound care leads in the three other devolved nations to ensure that they are sharing this learning across the piece.
The research in this area is also very important. The Department funds research into all aspects of human health through the National Institute for Health Research at the level of about £1 billion a year, and the NIHR has funded a number of studies focusing on lower limb wound care, including venous leg ulcers and vascular problems. A five-year funded programme on complex wounds comprised 11 new and updated reviews of the existing literature, a survey and interviews with people with complex wounds, their carers and health care professionals. There has also been a series of venous leg ulcer studies using randomised control trials to investigate the clinical and cost effectiveness of new versus traditional venous leg ulcer treatments from types of compression bandage through to compression hosiery to larval therapy.
The right hon. Lady also spoke about the importance of having the right staff, expertise and medically trained people to be able to deliver the care, and it is no secret that community nurses are a fundamental part of our health system; they provide vital services which ensure patients are treated where they are most comfortable, which often is in their own home, and that they are  supported to manage their conditions and to live independently. To help deliver our vision for community services, we are investing an extra £4.5 billion a year to spend on primary, medical and community health services by 2023-24. The key to delivering the long-term plans and vision is ensuring that we have the right nursing numbers, particularly in the community, and that is why the interim NHS people’s plan is prioritising taking urgent accelerated action to tackle some of the community nursing vacancies. That will be done in a range of different ways, including increasing supply through under- graduate nursing degrees, clearer pathways into the profession through the nursing associate qualification and apprenticeships, and tackling some of the misconceptions about the role of community nurses, which sometimes deter people from entering the profession. In addition, in May 2018 we announced £10 million for incentives to postgraduate students to go on to work in some of the areas that we care very passionately about and where we want to recruit the best people, such as mental health, learning disability and district community nursing roles.

Jim Shannon: I am pleased to hear this very positive response from the Minister. In Northern Ireland we have a very good community nursing programme that is delivered through the social care services. It cares for those who need care and a change of dressing for their wounds every day. The Minister referred to contact with the regions and devolved Administrations; will she contact the Northern Ireland Assembly and the permanent secretary of the Department of Health, Richard Pengelly, so they can give some idea of what we do there?

Caroline Dinenage: The hon. Gentleman is always full of brilliant ideas and we will only move forward as a nation if we share best practice and the expertise gained from different parts of our country. So I would be very keen to speak to his colleagues at the Northern Ireland Assembly and see if we can gain any learning from that.

Jamie Stone: I could not possibly let the occasion pass without commenting. Can I take it that that promise will be extended to the Scottish Parliament and the Scottish Government? The issue we have heard about today is no less a problem in Scotland.

Caroline Dinenage: Yes. We do not discriminate. We are keen to talk to everyone to get the best possible learning so that patients up and down the country can benefit from all the expertise that is available.
In thanking the right hon. Member for Cynon Valley for making the supreme effort to be here today, I reassure her that both the Government and the NHS recognise the importance of ensuring that patients have access to high-quality lower limb wound care and will continue to support the work of the national wound care strategy programme for England on improving the quality of wound care, including lower limb wound care, in the country. I thank her once again for being here to make her case so incredibly powerfully. I wish her a speedy recovery and send her all our love from this House.

Rosie Winterton: I echo the Minister’s warm comments about the right hon. Member for Cynon Valley (Ann Clwyd). We are all deeply impressed to see that she has come from her  hospital bed on the 12th floor of St Thomas’s to raise this important issue in the House. I have known and been a friend of the right hon. Lady for more than 30 years and I know her courage and resilience so it is not a great surprise that she has done so, but neverthelesswe are hugely impressed. Like the Minister, on behalf of the whole House, I wish her a speedy recovery and look forward to having her back full time in September.
Question put and agreed to.
House adjourned.